WHEN A DOCTOR NO LONGER ACCEPTS MEDICARE, PATIENTS CAN FACE A TOUGH TRANSITION
Betsy Carrier, 71, and her husband, Don Resnikoff, 79, relied on their primary care doctor for help managing their ailments.
But after seven years, the Maryland couple was surprised when the doctor informed them she was opting out of Medicare, the couple’s insurer.
“It’s a serious loss,” Resnikoff said. Patients can lose doctors for a variety of reasons, including a physician’s retirement or when either patient or doctor moves away. But economic forces are also at play. Many primary care doctors have argued that Medicare, the federal health insurance program for seniors and people with disabilities, doesn’t reimburse them adequately and requires too much paperwork to get paid.
These frustrations have prompted some physicians to experiment with converting their practices to more lucrative payment models, such as concierge medicine, in which patients pay a fee upfront to retain the doctor. Patients who can’t afford that arrangement might have to search for a new physician.
The number of doctors with concierge practices is unknown. One physician consulting company, Concierge Choice Physicians, estimates that roughly 10,000 doctors practice some form of membership medicine, though it might not strictly apply to Medicare patients.
Shawn Martin, senior vice president of the American Academy of Family Physicians, estimates that fewer than 3% of their 134,000 members use this model and that the number is slowly growing.
The move to concierge medicine could be more prevalent in wealthier areas.
Travis Singleton, executive vice president for the medical staffing company Merritt Hawkins, said doctors switching to other payment systems or those charging Medicare patients a higher price for care are likely “in more affluent, well-to-do areas where, frankly, they can get fees.”
It’s far easier for doctors than hospitals to opt out of taking Medicare patients. Most hospitals have to accept them since they rely so greatly on Medicare.
Most doctors still accept Medicare, and most people insured by the program have no problem finding another health care provider. But that transition can be tough, particularly for older adults with multiple medical conditions.
Shuffling doctors also heightens the risk of mishaps. A study of at least 2,200 older adults published in 2016 found that nearly 4 in 10 were taking at least five medications at the same time. Fifteen percent of them were at risk of drug-to-drug interaction.
Primary care providers mitigate this risk by coordinating among doctors on behalf of the patient, said Dr. Kellie Flood, a geriatrician at the University of Alabama Birmingham.
“You really need the primary care physicians to serve as the quarterback of the health care team,” said Flood. “If that’s suddenly lost, there’s really not a written document that can sum all that up and just be sent” to the new doctor.
Finding a physician who accepts Medicare depends partly on workforce demographics. From 2010 to 2017, doctors providing primary care services to Medicare beneficiaries increased by 13%, according to the Medicare Payment Advisory Commission (MedPAC), a nonpartisan group that advises Congress.
However, the swell of seniors who qualify for Medicare has outpaced the number of doctors available to treat them. Every day, an estimated 10,000 Americans turn 65 and become eligible for the government program, the Census Bureau reported.
The impact: In 2010, MedPAC reported, there were 3.8 primary care doctors for every 1,000 Medicare enrollees. In 2017, it was 3.5.
Authors of a MedPAC report out last June suggested that the number of available primary care providers could be an overestimate. Their calculation assumed all internal medicine doctors provided these services when, in reality, many specialize in certain medical conditions, or accept only a limited number of Medicare patients into their practices.
But MedPAC concluded seniors are not at a disadvantage finding a doctor.
“We found that beneficiaries have access to clinician services that is largely comparable with (or in some cases better) access for privately insured individuals, although a small number of beneficiaries report problems finding a new primary care doctor,” the MedPAC researchers wrote.
The coronavirus outbreak has complicated the ability for many Americans to access care, regardless of their insurer. However, many older patients now have an opportunity to connect with their doctors virtually after the Centers for Medicare & Medicaid Services broadened access to telemedicine services under Medicare.
Experts said the long-term effects of the virus on doctors and Medicare remain unknown. But Martin said the shortage of cash that many doctors are experiencing because of the coronavirus epidemic has revealed the shortcomings of how primary care doctors are paid.
“The COVID crisis really brought to life the challenges of fee-for-service,” said Martin.