More Doctors Opting Out of Medicare. Should we worry?

[SarahW]

Many of us are approaching (or are already enrolled in) Medicare. Several of my friends in the Houston area have advised me of the difficulty they have had finding doctors who will accept Medicare. I find this both annoying and worrisome, to say the least.

I was at my PCP earlier this week for lipid-panel results screening and he told me that his practice (5 doctors) is discussing discontinuing Medicare due to all the changes and requirements in 2015. Without getting into a political discussion, what does this mean for us going forward? This 2013 WSJ article pretty much sums it up... More Doctors Steer Clear of Medicare - WSJ

Will the aging population be shut out of proper health care? I'm concerned about this.

 

[rbmrtn]

Here's a 2013 study from Kaiser Foundation with a different view,

Medicare Patients’ Access to Physicians: A Synthesis of the Evidence | The Henry J. Kaiser Family Foundation

Main findings:

On a national level, Medicare patients have good access to physicians. The vast majority (96%) of Medicare beneficiaries report having a usual source of care, primarily a doctor’s office or doctor’s clinic.
Most people with Medicare—about 90 percent—are able to schedule timely appointments for routine and specialty care. Medicare seniors are more likely than privately insured adults age 50-64 to report “never” having to wait longer than they want for timely routine care appointments.

 

[SarahW]

Hmmm. Well, my own personal experience has not jived with that Kaiser report. I live in a major metro area and have been stymied by the lack of physicians accepting medicare. I called to schedule a routine colonoscopy just this morning (my father died of colon cancer) and was advised that the local GI group no longer takes Medicare patients. Frustrating.

Last year (before I became Medicare eligible), my then PCP dropped Medicare and a lot of my friends had to scramble to find a doctor. Maybe it's a local thing, but I am not liking what is happening here.

 

[Big_Hitter]

my parents live in Houston and are saying the same thing - tough to find a doc right now

 

[Walt34]

I haven't run into the issue yet but then I just started on Medicare just a few months ago. And I have a secondary policy that picks up where Medicare leaves off.

 

[braumeister]

Last time I checked, roughly 15% of the US population was over 65, so on Medicare. That's a pretty big group of people to exclude from your services, especially as that group is more likely to need medical care than younger folks.

 

[Big_Hitter]

Last time I checked, roughly 15% of the US population was over 65, so on Medicare. That's a pretty big group of people to exclude from your services, especially as that group is more likely to need medical care than younger folks.

I think Houston has a younger demographic and the docs there can afford to be picky.

 

[MichaelB]

Here's a link to the 2015 MedPac Report to Congress (here). It has lots of data, including separate measurements of beneficiaries difficulty in getting appointments / changing doctors, and health care providers accepting Medicare and new patients (see pages 83 thru 92).

This report shows no significant change over the past 5 years reported by beneficiaries or providers, they also believe neither is an issue. They do highlight one area of higher dissatisfaction, which is getting a new primary care physician. This may be a problem, but not so much Medicare caused, more a reflection of the growing number of graduating physicians choosing specializations over primary care.

 

[sengsational]

Ten years until I get there, I hope it gets better (or no worse) by the time I get there.

It might start to become more important to select a retirement location base on how picky the doctor force is at the possible destination. On the other hand, the US tends to be fairly uniform. Due to the higher mobility we have here versus, say Europe, strong differences tend to level themselves out.

 

[rodi]

I think the issue is along the lines of the concierge doctors who no longer take any insurance at all. A small percentage of doctors can follow that model - but not the majority - since most of us rely on insurance to pick up some of the cost and to negotiate rates.

Too many doctors decide to dump medicare - and they find themselves chasing fewer and fewer patients.

I'm on a closed network system (Kaiser Permanente) - they have a medicare compatible HMO plan that I plan to transition to once I reach medicare age.

 

[W2R]

I haven't run into the issue yet but then I just started on Medicare just a few months ago. And I have a secondary policy that picks up where Medicare leaves off.

I do too, as a federal retiree. But from what I understand, Medicare dictates how much the doctor gets, and then my FEHB/BCBS policy picks up where Medicare leaves off in paying at those Medicare rates. I could be wrong! But this is how I understand it.

My doctor takes Medicare patients and so I haven't had any problems. That could be blind luck.

 

[Walt34]

I do too, as a federal retiree. But from what I understand, Medicare dictates how much the doctor gets, and then my FEHB/BCBS policy picks up where Medicare leaves off in paying at those Medicare rates. I could be wrong! But this is how I understand it.

Oh, I didn't know the part about Medicare dictating the total fee. My secondary is BCBS and is likely similar to the federal one as my former employer tended to follow the federal benefits fairly closely.

 

[rbmrtn]

There is a physician finder on the medicare site, Medicare.gov Physician Compare Home

I live in a somewhat rural area but seems to be plenty of Drs accepting medicare, but who knows what will be, I'm over 10yrs away from it.

 

[Bikerdude]

Since I've been on Medicare the doctors spend about half the time they used to during an appointment. Two and half minutes instead of five.

 

[Texas Proud]

I think that the problem is that it is tough to find a doctor you might like. This is pure guess on my part, but I think that docs that have more than enough patients tend to shy away form Medicare.... so you get newer docs or foreign docs.... not all people like foreign docs.... for some reason they think they are not as good....

My mom has been going to the same doc I have... but he is very booked and you might not get an appointment for up to 2 months at times...

 

[harley]

Well, since we've moved (mainly) to FL, most of the patients AND doctors there are on Medicare, so I don't think I'll have too much problem finding one when the time comes.

 

[Silver]

Well, since we've moved (mainly) to FL, most of the patients AND doctors there are on Medicare, so I don't think I'll have too much problem finding one when the time comes.

I live in central Florida, the Orlando area, and physicians refusing all new patients with medicare has become a significant issue. These are both primary care and specialty physicians. They are keeping their established patients, but will not accept new patients on medicare, even with a supplemental policy. It just does not reimburse enough.

 

[cooch96]

I think many more middle and upper class seniors are going to transfer to concierge care for typical issues simply for the improved service. Hopefully this will lessen the strain on the Medicare system and the indigent elderly will get adequate care.

I also expect to see a lot more of the near wealthy to take advantage of US trained doctors who set up practice in places like Thailand. Fly to a tropical land, check into a luxury hospital, get your knee replaced, and convalesce in paradise for a cost cheaper than economy service in the States.

I could be very wrong; we shall see. But that's the real motivation of trying to be rich, right? To be able to afford options in case a whole system collapses.

When I was active duty, I went to private doctors because the quality of care at the post hospital was so abysmal. I could afford out-of-pocket care as an officer, especially since I was young and generally healthy.

 

[SarahW]

There is a physician finder on the medicare site, Medicare.gov Physician Compare Home

I live in a somewhat rural area but seems to be plenty of Drs accepting medicare, but who knows what will be, I'm over 10yrs away from it.

I used that finder recently and found several doctors listed who actually don't accept Medicare when I called to inquire.

 

[SarahW]

Since I've been on Medicare the doctors spend about half the time they used to during an appointment. Two and half minutes instead of five.

I've only been on Medicare for a month or so, but so far I am not impressed. I wish I could have stayed with my Aetna HMO. I do not have a warm fuzzy feeling about the doctors I'm finding available to me.

 

[Bamaman]

Physicians are in business to treat people and get them well. They're so frustrated now that Medicare dictates to them how much they're going to pay for services, and they have to often fight Medicare to get them to pay for specific tests for their patients. Doctors get frustrated spending hours per week on the phone arguing with Medicare administrators--that are not even government employees.

And when they charge Medicare for a simple little CBC test (for white blood cells,) they receive virtually nothing for their time and their office's time.

Many doctors talk of refusing Medicare patients. But when it gets down to it, they'd be out of business trying to doctor the 20 and 30 year olds.

When doctors get to the point that they quit Medicare, they'll also be quitting being physicians. My wife already has one 55 year old doctor that's running a coffee shop in Memphis.

It's a shame that doctors never figured out they're middle class. The cost of keeping up a big house, two nice cars and sending the kids to private schools just about takes what most doctors make. Most physicians don't have the cash flow to 100% fund a substantial retirement program, and even fewer make good investment decisions. That causes doctors to work into their late 60's or 70's while their friends have retired 10-15 years earlier.

 

[Bamaman]

I've only been on Medicare for a month or so, but so far I am not impressed. I wish I could have stayed with my Aetna HMO. I do not have a warm fuzzy feeling about the doctors I'm finding available to me.

We're the same age. By going on Medicare and getting my ex-employer's Medicare Supplement, my paycheck just increased about $250 per month.

I still have superior health coverage than most of the public, and I am very thankful for that. As a type II diabetic and having a wife that had female cancer, we'd be uninsurable on the open healthcare market.

 

[ERhoosier]

I'm not on Medicare yet, but the '12 MedPAC study and 2013 Kaiser report describe a WHOLE lot rosier picture than the recent experiences of my older relatives in multiple regions of the country. Examples: One close relative of mine had a HUGE difficulty finding ANY orthopedist who would care for her (via ER referral) after she had a serious knee ligament injury falling on the ice. Another waited 2 months to see any neurologist accepting new Medicare patients. In the same regions, other younger relatives with private insurance needing same specialties were seen within a week. And those regions all have well over 90% of docs reportedly accepting new Medicare patients (according to Kaiser article).
BTW- Kaiser article is not new data but a "synthesis" of prior studies with some of the material presented dating back 5-6 years. The overall US healthcare market has changed markedly in that time, and possibly Medicare has too.