Repairing the Healthcare System: Physicians Opting Out Of Medicare And Obamacare

Stanley Feld M.D.,FACP,MACE

I have discussed the disillusionment of Obamacare by several major stakeholders, hospital systems, insurance companies, union leaders and large corporations in my last three blog posts.

As Obamacare gets more complicated physicians are opting out of Medicare and will not participate in Obamacare.

All most physicians want is to practice the best medicine they can using their intellectual property or surgical skills.

Physicians are people who want to help people. They are not street crooks.

Obamacare is trying to commoditize medical care, decrease physician value and reimbursement.

Commoditization of medical care will decrease physicians’ freedom to exercise their medical judgment. Medical decision-making will be in the hands of distant involved bureaucrats. Access to care will be determined by bureaucratic rules and not the patients and their physicians.

Physicians are opting out of Medicare, Medicaid and Obamacare. They have become totally frustrated with Medicare and Medicaid reimbursement rates and the mounting rules and regulations.

Marilyn B. Tavenner R.N., the administrator of the Centers for Medicare and Medicaid Services told congress that an insignificant number of physicians have dropped out of Medicare and Medicaid. This is clearly not true.

A CMS report said 9,539 physicians who had accepted Medicare in the past opted out of the program in 2012, up from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.

The number of physicians opting out of Medicare last year nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services.

This is not an insignificant number of physicians when America is experiencing a shortage of primary care physicians.

“A study in the journal Health Affairs this month found that 33% of primary-care physicians didn't accept new Medicaid patients in 2010-2011,” even though they continue to participate in Medicare.

Some physicians are limiting the number of Medicare patients they treat even if they don't formally opt out of the system.

The reason is Medicare reimbursement is so low and getting lower. It some cases reimbursement is lower that the cost to deliver the care.

A study found that 4% of family physicians are now in cash-only or concierge practices.

The Obama administration issued an executive order this year where Medicare would not reimburse anything to patients paying cash to non-participating physicians.

This is putting an increased burden on Medicare patients.

“All told, health experts say the number of doctors going "off-grid" isn't enough to undermine the Affordable Care Act.”

The Obama administration’s bureaucrats are not facing reality. Today, before the expansion of Medicaid it is difficult for Medicare and Medicaid patients to find a physician.

Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can't find doctors willing to treat them.

Many physicians will not accept Medicaid patients. CMS administrators want the public to believe this is not true. They say the number of physicians not taking Medicaid is insignificant.

Medicaid physicians have to see as many as 200 patients or more a day to make a living. There are not enough minutes in a day to see that many patients and have a quality care visit. These physicians have employees who are seeing patients for them. These physicians then sign off as seeing the patient.

This volume then triggers a probe on their practices and accusations of fraud. As Medicaid gets expanded through Obamacare to cover the uninsured, there will be even fewer and fewer Medicaid physicians and a greater physician shortage.

Medicaid physicians are not interested nor can they take the government abuse.

Employers are cutting back on hiring full time employees and hiring part time employees to avoid the rising insurance costs.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, told Congress that she had heard of only “isolated incidents” in which employers tried to cut back hours. Representative Steve Scalise, Republican of Louisiana, told her that she must be “living in some cocoon” because he heard of such actions almost every day.

Every large corporation is converting as many full time workers to part-time workers as possible because of Obamacare in order to avoid the Obamacare mandate. Part-time workers have felt the disastrous impact on wealth production and economic activity.

These are the revised statistics from the Bureau of Labor Statistics for May and June.

The establishment survey showed a gain of 162,000 jobs.  The previous two months were revised lower. The employment change for May revised down by 19,000 (from +195,000 to +176,000), and the employment change for June revised down by 7,000 (from +195,000 to +188,000).  The unemployment rate dropped 0.2 to 7.4%.   Explaining the Unemployment Rate Drop 

Employment rose by 227,000 of which 103,000 were part-time jobs.
The Civilian Labor Force Declined by 37,000 even though population rose by 204,000.
Those "Not in Labor Force" rose by 240,000.
Participation Rate fell 0.1 to 63.4%, a mere 0.1 higher than the low of 63.3% dating back to 1979.

July BLS Jobs Statistics at a Glance

Payrolls +162,000 - Establishment Survey
US Employment +227,000 - Household Survey
US Unemployment -263,000 - Household Survey
Involuntary Part-Time Work +19,000 - Household Survey
Voluntary Part-Time Work +84,000 - Household Survey
Baseline Unemployment Rate -0.2 - Household Survey
U-6 unemployment -0.3 to 14.0% - Household Survey
Civilian Labor Force -37,000 - Household Survey
Not in Labor Force -240,000 - Household Survey
Participation Rate -0.1 at 63.4 - Household Survey

Marilyn B. Tavenner making the above statement to congress makes her a liar or a person not in touch with reality. Have can the American people entrust our healthcare decisions to these bureaucrats?

The Obama administration needs both the primary and secondary stakeholders’ cooperation if Obamacare has the slightest chance of succeeding.

I do not think Obamacare can survive. It will sink under its own weight as it tries to control all of the stakeholders through oppressive regulations without regard for their vested interests.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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