Monday, July 9, 2012

Alarming Drop in Physician Acceptance of Medicaid, Medicare Patients

TMA physician leaders have long predicted government regulatory burdens, red tape, payment hassles, and low pay would erode the physician foundation of both Medicaid and Medicare.

That day has come, according to TMA’s new biennial survey of Texas physicians. More physicians are forced to reduce the number of patients they see who depend on government insurance for their health care. “All the bureaucratic red tape and administrative burdens only serve to increase the cost of running a practice while diverting a physician’s attention away from patient care,” said TMA President, Michael E. Speer, MD.

Hardest hit are low-income Texans who rely on Medicaid for their care. Texas physicians available to treat new Medicaid patients have plummeted from 42 percent in 2010 to 31 percent — an all-time low.

Medicare, a federal health program that insures seniors, people with long-term disabilities, and military families, also saw a huge decline. The number of Texas physicians accepting all new Medicare patients dropped from 66 percent in 2010 to 58 percent in 2012. That’s part of a trend that’s seen the number decline steadily from 78 percent in 2000. Meanwhile, the number of Texas physicians who limit how many new Medicare patients they accept, and the number who decline all new Medicare patients each rose by 4 percent in the past year.

Dr. Speer said these are the lowest-ever new-patient acceptance rates the association has seen. He’s saddened but not surprised. “Doctors have answered the government mandate to invest in expensive health information technology, upgraded their coding and billing systems, implemented e-prescribing programs, withstood the threat of a new 60,000-item medical coding system (ICD-10), and for the past decade endured the payment uncertainty of Medicare,” he explained.

To make matters worse, in 2010 and 2011, the state cut physicians’ already-meager Medicaid payment rates another 2 percent. Then, at the start of this year, doctors who care for the state’s poorest elderly and disabled patients (dual-eligible patients) were cut another 20 to 100 percent. These cuts hit physician practices extremely hard, especially because Medicaid payments cover less than half of the average cost to provide services. “Every business has a breaking point; physicians’ practices are no different,” said Dr. Speer.

Joannie Parr, a Sugar Land accountant, manages her husband’s medical practice. Thomas J. Parr, MD, is an orthopedic surgeon. “Some years ago, we looked at expenses and income, and made the difficult decision to stop accepting Medicaid patients,” she said. “Medicaid puts up so many hurdles we found it was easier to provide free care outright than hassle with Medicaid’s bureaucracy for basically no pay.” Dr. Parr now treats low-income patients referred to him by a free clinic and volunteers his surgical services at a local hospital.

Another critical issue not addressed in the Patient Protection and Affordable Care Act (PPACA) is the faulty formula Medicare uses to pay physicians. Doctors have faced the threat of steep Medicare payment cuts every year for more than 10 years. Once again, physicians face a nearly 30-percent cut Jan. 1, 2013. Instead of addressing Medicare’s flawed payment formula, the PPACA has added even more layers of bureaucracy.

Su Zan Carpenter, MD, a family physician in Angleton, Texas, recently opted out of Medicare. “Every time you turn around someone has a new rule or a new regulation or a new audit or a new inspection or a new something,” she said. “There’s a point where enough is enough. You need to see the patient, talk to the patient, examine the patient, and actually do something with your patients for your patients. All that stuff is starting to get in the way of practicing medicine and helping people.”

Frisco family physician Chris Noyes, MD, says he had a “straw that broke the camel’s back moment” with Medicare in 2009. “I had a patient who moved from out of state to be with his kids. He had lung cancer when he came in, and he ultimately died. We wrote off a fairly large balance,” Dr. Noyes said. “Two years after he died, we got a letter from Medicare saying they had overpaid for a flu shot for him by $2 and they wanted the money back with interest and a penalty, and if I didn’t pay it all within 30 days they would prosecute me.” These stories are no longer isolated incidents but stories that are becoming more common across the state.

“What’s lost in the health care debate is the simple fact that patients need a doctor when they get sick. And physicians want to take care of patients and not push endless reams of paper around our desk,” said Dr. Speer. “At some point, state and federal leaders must realize without an adequate network of physicians, no health care system can work, let alone be effective.”

TMA recently published its strategic roadmap, titled Healthy Vision 2020. The document outlines the association’s state and federal recommendations to ensure patients have the right care, at the right place, and at an affordable price.

Survey Methodology
Since 1990, TMA has conducted a biennial survey of a representative sample of Texas physicians focusing primarily on health care practice, economic, and legislative issues. The survey findings provide a cross-sectional snapshot and a longitudinal tracking of physician opinions on key health care issues and their experiences to support the association’s policy development, political focus, and strategic planning process. The 2012 Survey of Texas Physicians was conducted by TMA as a monthly e-mail survey. Approximately 27,917 Texas physicians were e-mailed a personalized link to the first part of the survey along with an announcement outlining the purpose of the survey. Preliminary data was gathered from 1,139 physicians for a response rate of 4 percent.

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