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Life Health > Health Insurance > Medicare Planning

Feds insist doctors still take Medicare

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Though there have been concerns over doctors fleeing the Medicare program, the feds have a rebuttal to those claims: Not so fast.

They say Medicare is picking up providers, and the percentage accepting new patients is holding steady.

According to a brief released by the Department of Health and Human Services, the number of providers who bill Medicare directly rose about 90,000 between 2007 and 2011, and the number of providers who charge their patients for covered procedures — the ones who “opt out” — increased by about 110,000, citing figures compiled by the Centers for Medicare & Medicaid Services. The chart included in the brief shows about 1.02 million of the former, and 980,000 of the latter.

The HHS brief also says the percentage of providers accepting new Medicare patients held fairly steady between 2005 and 2012, and is comparable to the percentage of providers accepting new privately insured patients.

Most recently, about 91 percent of providers accept new Medicare beneficiaries and 86 percent accept new privately insured patients, according to a cited survey by the National Center for Health Statistics.

Another report cited in the brief, MedPAC’s March, 2013 Report to Congress, showed that, in general, about three-quarters of all patients, regardless of the type of health insurance they have, report having no problem finding a new physician who will accept their coverage, or having to wait longer than they want for an appointment.

According to an article in USAToday, HHS commissioned the report after a July Wall Street Journal article claimed the number of Medicare full-benefits providers is shrinking, and fewer are taking new patients.

The Journal article said the number of providers who chose to opt out rose about by about 6,000 between 2009 and 2012. Opting out involves a contract between the patient and the provider that can last for two years. With that arrangement the patient pays the provider for a covered service up front — at a rate up to 15 percent over what a non-participating provider is paid by Medicare — and the beneficiary is reimbursed by Medicare at the covered rate. So while a beneficiary in an opt out arrangement with a provider does still receive Medicare benefits, they end up paying more out-of-pocket than if the provider had accepted assignment directly from Medicare.

But despite the increase in providers opting out, HHS says it is well offset by the increase in the number of providers joining the Medicare system, and beneficiaries are not being adversely affected.

According to the HHS brief, a 2005 study found that psychiatry (1.11 percent) and plastic and reconstructive surgery (1.56 percent) were the specialties showing the highest opt-out rates. Primary care physicians, it said, opt out at a rate of .35 percent.

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