How many doctors are really refusing to treat Medicare patients?

It’s a simple enough question. But it’s also one of many politically charged questions in healthcare, and politics makes for elusive answers. If you’re a doctor or a physicians’ trade group angling for higher reimbursements from Medicare, you make the case that a lot of doctors are leaving because they need more money. If you’re a patient advocate, you insist beneficiaries are still getting care although anecdotally you’ve heard a few docs have left the program. If you’re a journalist on deadline, you take the middle road and resort to he said/she said to fill your story, an approach that produces something less than illuminating journalism. Or in some cases you may simply write your story around a press release from the local medical society.

But last Wednesday, Dan Diamond of California Healthline contributed an interesting nugget to the discussion. Diamond was responding to a Wall Street Journal piece published the end of July, which made the case that docs are indeed increasingly leaving Medicare for the proverbial greener pastures of private-pay care—and which itself brought lots of studies and figures to the table.

The Journal had reported that last year, according to the Centers for Medicare and Medicaid Services, 9,539 physicians opted out of Medicare, up from 3,700 in 2009. It noted an American Academy of Family Physicians survey that found the proportion of family physicians accepting new Medicare patients was 81 percent last year, down from 83 percent in 2010. Furthermore, the Journal reported, reimbursement rates weren’t the only issue: some doctors were dropping out of the system because Medicare is too intrusive in their practices. Mary Jane Minkin, a gynecologist at the Yale School of Medicine, quit when she saw patients’ gynecological records displayed on electronic records which made them available to other providers they consulted. “There’s no reason the dermatologist has to know about my patients’ libido issues,” she told the paper.

Reasonably interesting stuff. But also somewhat incomplete, as Diamond writes:

What the Journal didn’t report is that, per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.

And other providers aren’t turning down Medicare, either. The number of nurse practitioners participating in the program has only gone up, Jan Towers of the American Academy of Nurse Practitioners told California Healthline.

The Journal story had plenty of caveats, but the overall framing and the front-page headline—“More doctors steer clear of Medicare”—put all the focus on the rise in the number of opt-out physicians. An increase in the number of participating physicians seems worthy of mention, too.

Consider also that even after the sharp increase, the number of doctors who left in 2012 was a little more than one percent of all participating physicians that year. Is that a big deal? The answer depends on where you stand.

Diamond’s blog post—which has plenty of caveats itself, and acknowledges
real frustrations among physicians—is a useful corrective. It’s one to keep bookmarked for the next time this debate comes up, as it surely will.

Follow @USProjectCJR for more posts from this author and the rest of the United States Project team.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.