05/19/10
Texas doctors opting out of Medicare at alarming rate
By TODD ACKERMAN
HOUSTON CHRONICLE
Texas doctors are opting out of Medicare at alarming rates, frustrated by
reimbursement cuts they say make participation in government-funded care of
seniors unaffordable.
Two years after a survey found nearly half of Texas doctors weren't taking some
new Medicare patients, new data shows 100 to 200 a year are now ending all
involvement with the program. Before 2007, the number of doctors opting out
averaged less than a handful a year.
“This new data shows the Medicare system is beginning to implode,” said Dr.
Susan Bailey, president of the Texas Medical Association. “If Congress doesn't
fix Medicare soon, there'll be more and more doctors dropping out and Congress'
promise to provide medical care to seniors will be broken.”
More than 300 doctors have dropped the program in the last two years, including
50 in the first three months of 2010, according to data compiled by the Houston
Chronicle. Texas Medical Association officials, who conducted the 2008 survey,
said the numbers far exceeded their assumptions.
The largest number of doctors opting out comes from primary care, a field
already short of practitioners nationally and especially in Texas. Psychiatrists
also make up a large share of the pie, causing one Texas leader to say, “God
forbid that a senior has dementia.”
The opt-outs follow years of declining Medicare reimbursement that culminated in
a looming 21 percent cut in 2010. Congress has voted three times to postpone the
cut, which was originally to take effect Jan. 1. It is now set to take effect
June 1.
Not cost-effective
The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family
practice doctor who says he wrestled with his decision for years before opting
out in March. It was, he said, the only way “he could stop getting bullied and
take control of his practice.”
“You do Medicare for God and country because you lose money on it,” said
Culpepper, a graduate of the University of Texas Medical School at Houston. “The
only way to provide cost-effective care is outside the Medicare system, a system
without constant paperwork and headaches and inadequate reimbursement.”
Ending Medicare participation is just one consequence of the system's funding
problems. In a new Texas Medical Association survey, opting out was one of the
least common options doctors have taken or are planning as a result of declining
Medicare funding — behind increasing fees, reducing staff wages and benefits,
reducing charity care and not accepting new Medicare patients.
In 2008, 42 percent of Texas doctors participating in the survey said they were
no longer accepting all new Medicare patients. Among primary-care doctors, the
percentage was 62 percent.
The impact on doctors has not been lost on their patients. Kathy Sweeney, a
Houston retiree, twice has been turned away by specialists because they weren't
accepting new Medicare patients. She worries her doctors might have to drop her
if Medicare cuts go through and they can't afford to continue in the program.
“I've talked to them about the possibility,” said Sweeney, who sent her
legislators a letter calling on them to fix Medicare. “They're hanging in there
as long as there's not a severe cut, but just thinking I couldn't continue
doctor-patient relationships I built up over years is disturbing. Seniors should
be able to see the doctors they want.”
The problem dates back to 1997, when Congress passed a balanced budget law that
included a Medicare payment formula aimed at reining in spending. The formula,
which assumed low growth rates, called for payment cuts if spending exceeded
goals, a scenario that occurred year after year as health care costs grew. The
scheduled cuts, expected to be modest, turned out to be large.
Congress would overturn the cuts, but their short-term fixes didn't keep up with
inflation. The Texas Medical Association says the cumulative effect since 2001
already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors
receiving a $1,000 Medicare payment made roughly $410, after taking out
operating expenses. In 2010, they'll net $290. If the scheduled 21.2 percent cut
goes through, they'd net $72, effectively an 83 percent cut since 2001.
The issue caused the Texas Medical Association to break ranks with the American
Medical Association and oppose health care reform efforts throughout 2009. Then
TMA President Dr. William Fleming said “reform is doomed to failure” without
Medicare reform and called Congress' failure to devise a rational payment plan
“an insult to seniors, people with disabilities and military families.”
No surprise to senator
U.S. Sen. John Cornyn, R-Texas, said he isn't surprised by the new opt-out
numbers, allowing that Congress' inability to reform Medicare is leaving
“seniors without access and breaking the promise we made to them.”
“The problem has been how to eliminate the cuts without running up the deficit,”
said Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on the
Senate for not passing a House bill that would have provided a longer-term
Medicare fix. “There hasn't been the political will, but we really have no
choice but to fix it.”
Cornyn acknowledged the task is daunting. The Congressional Budget Office
recently estimated that eliminating scheduled Medicare payment cuts through 2020
would cost $276 billion.
The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors
notified Trailblazer Health Enterprises, the state's Medicare carrier, they
would no longer participate, up from seven in 2006. The numbers jumped to 151 in
2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to
2002, by contrast, no more than three a year opted out.
Now, according to a Texas Medical Association new poll, more than four in 10
doctors are considering the move.
“I've been in practice 24 years, and a lot of my patients got old right along
with me,” Culpepper said. “It's stressful to tell them you're leaving Medicare
and they're responsible for payments if they want to stay with you. You feel
like you're abandoning them.”
todd.ackerman@chron.com
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We're all going to face this sooner or later. I'm there now. You may be younger and hoping something happens to improve the situation before you reach Medicare age. I hope so too. I have a lot of younger friends and relatives that don't deserve to end up like this.
Ironic that the people who created the problem will not be depending on the failed Medicare for their health when they grow older. Congress thinks they'll be enjoying their gold-plated federal health plan in their old age. But a lot of folks are thinking seriously about whether those congress critters are going to have an old age.
Personally, I wouldn't do anything to actively deprive them of life, but I would delight in seeing them trying to survive with the same conditions and resources that they have given to the rest of us.