Primary Care Physicians Are Leaving Medicare
by Devon Carlin
Washington, DC - Physicians are fleeing Medicare, and primary care physicians most of all, says a just-released paper by David Hogberg, Ph.D. for the National Center for Public Policy Research. Furthermore, action to reform Medicare to address the problem must be taken soon if American seniors and future retirees are to maintain meaningful access these critical doctors.
Dr. Hogberg is Washington Correspondent for Investor's Business Daily and a former health care policy analyst for the National Center for Public Policy Research. His new paper, "The Next Exodus: Primary-Care Physicians and Medicare," examines the problem, its causes, and a proposed solution to the growing crisis.
The problem: Surveys indicate about 17 percent of all doctors nationally are refusing to treat new Medicare patients, and the trend is worse among primary care physicians, who typically are the elderly's first line of defense against disease and infirmity.
In fact, says Hogberg, "the Medicare population is one that may be in the most need of primary care. Patients with multiple illnesses -- in medical lingo 'comorbidities' -- are most likely to be found among the elderly and the disabled. Considerable evidence shows that primary care is vital to effectively treating people with comorbidities."
The causes: Medicare's bureaucratic payment structure is one cause of the exodus of primary care physicians, who face a bias within Medicare that favors higher payments to specialists. A primary care physician in Austin, Texas can expect to be paid just $19.78 for a 10-15 minute visit with an established patient with a minor ailment, for example, and must pay overhead - office, equipment and staff - from that sum.
Other factors, Hogberg says, include massive amounts of unreimbursed time on billing, the very real threat of prosecution for honest billing differences, conflicts of interest within systems setting payment rates, and Congress' refusal to end the "Sustainable Growth Rate."
The solution: Medicare must be reformed if the system is to stop driving primary care physicians away. Hogberg suggests a solution.
Hogberg says, "The best way to do this is to give Medicare funds to Medicare beneficiaries and let them pay their physicians directly. Each year Medicare should deposit $1,200 in a 'Medicare Primary Account' for every beneficiary. Under such a system every primary-care physician could charge his Medicare patients what he believed was a reasonable price for a visit. If the patient agreed, he would pay the physician directly out of the Medicare Primary Account using either a debit card or a checkbook that would come along with the account. If the Medicare patient felt the price was unreasonable, he could look around for a physician whose prices he thought were better."
In the paper, Hogberg raises and answers the following questions and more:
What percentage of doctors are refusing to see Medicare patients, and is the trend growing?
How can refusing to accept Medicare improve a doctor's ability to serve his senior citizen patients?
How is Congress repeatedly making it harder for doctors to accept Medicare?
How do Medicare codes for dolphin bites - and "getting bitten by a dolphin in a subsequent encounter" - exemplify the needlessly complicated Medicare coding system, which frustrates many doctors and drives up administrative costs?
How does Medicare decide what to pay doctors, and does the system make any sense?
How much money do primary care practices make, and how much is eaten up with expenses?
How might Medicare be reformed to stop the exodus of primary care physicians, and better serve patients?
Far from being a dry analysis, Hogberg's paper provides case studies of two primary care physicians, Dr. Juliette Madrigal-Dersch Marble Falls, Texas, and Dr. John Slatosky of Randleman, North Carolina. Hogberg uses the experiences of these doctors to illustrate the ways Medicare's current structure harms doctors' ability to provide optimum service to patients.
Dr. Hogberg's paper, "The Next Exodus: Primary-Care Physicians and Medicare," is available online at http://www.nationalcenter.org/NPA640.html. David Hogberg, Ph.D. is Washington Correspondent for Investor's Business Daily and a former health care policy analyst for the National Center for Public Policy Research.