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Government abandons study of Medicare opt-outs


A quest to determine why physicians drop Medicare from their practices, and what effect it has on healthcare has ended in failure. See what roadblock got in the way.

Little data exist to explain why physicians drop Medicare from their practices, according to a report released by the Office of the Inspector General (OIG).

In April 2011, the OIG began the study “Impact of Physicians Opting Out of Medicare.” Researchers wanted to determine why doctors opt out of the Medicare program and the effects of opt-outs on Medicare beneficiaries.

The OIG determined that the Centers for Medicare and Medicaid Services (CMS) and its contractors do not maintain sufficient data regarding physicians who opt out of Medicare. As a result, they were unable to conduct the proposed evaluation.

The OIG obtained a list of approximately 7,900 providers who opted out of Medicare from 1998 to 2011. CMS officials told the OIG the list was compiled from directories of opted-out providers posted on CMS contractor Web sites. The OIG also requested opt-out lists from 16 contractors.

“We were unable to answer the issue questions in our proposed study because no centralized data exist, and the data that we received from [contractors] were insufficient or not provided at all,” the OIG study authors wrote. “Specifically, we cannot determine the characteristics of physicians who opt out of Medicare, the trend in the number of opted-out physicians, and why physicians choose to opt out of Medicare.”

In 2011 CMS issued guidance to its contractors on maintaining data on doctors who opted out on or after January 1, 2009. The OIG study authors, however, wrote that they would require more data from 1998 to 2008 before it would draw any conclusions.

In August 2011, the Texas Medical Association (TMA) released the results of a survey of its 45,000 members showing that half of them said they would consider dropping Medicare. The members’ main complaint was the formula used to calculate Medicare payments to physicians, called the sustainable growth rate (SGR), which attempts to hold compensation growth even with gross domestic product. Congress has stepped in every year for a decade to block payment cuts that were called for under the SGR formula.

“The number of Texas physicians who may be forced to leave Medicare if Congress doesn’t fix the program is staggering,” said TMA President C. Bruce Malone, MD, in a statement. “It’s tragic. Medicare simply cannot work without physicians to care for the millions of patients who depend on it. Congress can’t wait any longer.”

Doctors have until February 14 to opt out of Medicare.

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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health