The primary care physician shortage in the U.S. is well documented. The health care reform law will increase pressure on these doctors as it goes into effect. Add this to news that more doctors are opting out of Medicaid and Medicare, and the situation appears critical.
According to the Houston Chronicle, doctors in Texas are essentially fleeing Medicare. The program provides health insurance coverage to people age 65 and older and those who meet certain criteria. Because of lower reimbursement rates and other problems, many physicians are no longer accepting Medicare patients. An excerpt:
“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.”
As expected, primary care physicians represent the largest portion of doctors dropping the program. One family practice doctor said the only way to provide cost-effective care and avoid Medicare’s red-tape and insufficient reimbursements is to opt out.
As the enormous baby boom generation begins to retire, many will join the Medicare program. The doctor shortage they’ll face, at least in Texas, will be unprecedented. In the last two years, about 350 Texas doctors have dropped the program. In 2008, 62 percent of Texas doctors opting out of Medicare were primary care physicians.