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Threats to Medicare funding jeopardize physician participation


How long they can play the Medicare payment shell game without simply walking away from the table?

Stop taking insurance in the first place.

That’s what we at Medical Economics inevitably hear when we write about dealing with payer (both commercial and public) obstacles and how physicians can overcome them to get paid what they deserve. 

For the vast majority of our readers, this isn’t a reality, especially when it comes to government-insured patients. Many physicians don’t want to abandon long-time patients by turning to concierge medicine or starting a direct primary care practice. There are hybrid models, of course, and some doctors do go that route to keep patients with insurance while also accepting direct payment to avoid payer hoops.


HOT TOPIC: Physicians leaving medicine because of EHRs


But a large portion of U.S. primary care physicians (93% at last count by the Kaiser Family Foundation), continue to accept Medicare and the program is still considered the rate standard-setter for many private insurers. Even so, that doesn’t mean participation comes without frustration for physicians and this year could test their limits.

Next: More physician frustration



There is, of course, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its data collection, storage and reporting challenges in order to avoid a payment cut for services rendered two years later. The legislation also mandated 0.5% annual payment updates, but to date, the total payment update since passage is 0.7% - not the 1.5% promised.

And as physicians struggle to succeed-and in some cases just understand-Medicare’s Quality Payment Program, Congress is poised to muddy the waters a little bit more.

House Speaker Paul Ryan has tipped his hand on his party’s priorities, singling out Medicare as “the biggest entitlement that’s got to have reform,” in a radio interview last year. With the passage of a massive tax cut bill comes the need to pay for it and if Medicare is indeed targeted, it would affect both patients and physicians.  

And then there is the Protecting Access to Medicare Act, passed in 2014, which directed the U.S. Health and Human Services Department to work alongside physicians to identify misvalued codes for medical services. Any savings identified from this process was to be redirected to undervalued medical services.


MORE: Does ONC's latest announcement move interoperability any closer to reality?


The good news is that the partnership found savings. The bad news is those savings were used to cover funding shortfalls outside of Medicare, eliminating potential boosts to physician payment. 

So to recap: Physicians must submit MACRA data or face a decrease in Medicare payments. And in 2019, per the legislation, there will be 0% payment updates. Doctors also aren’t realizing any benefits of Medicare savings from identifying misvalued procedures. 

Physicians are a noble lot. They want to help patients. But they are also business people with bills to pay and families to support through their hard work and dedication. As altruistic of many of them want to be, one has to wonder how long they can play the Medicare payment shell game without simply walking away from the table. 


Keith L. Martin is editorial director for Medical Economics. Would you consider leaving Medicare? If so why? Tell us at

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