Surprise, Surprise just as predicted by the medicare Chief Actuary, doctors are abandoning Medicare because of years of cuts in their pay which get locked in thanks to Obamacare.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since. 

Every year congress passes a “fix” to protect the doctor’s meager medicare payments. A fix was an essential part of of the Obamacare bill, since it makes medicare an integral part of everyone’s health care, however it was cut out of the bill and was forced to be  treated separately because it made the Obamacare plan show a bigger loss.

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This month, the Senate passed its fourth stopgap fix this year – a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have already been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to convince Congress to suspend the 25 percent rate cut that the SGR method will require next year.

Such temporary reprieves have increased the potential pain down the road, compounding not only the eventual cut but the cost of doing away with it for good, now estimated in the tens of billions.

The lobbying blitz by doctors also comes amid concern in Washington that Medicare spending is spiraling up so fast the nation can’t afford to boost it further by significantly raising doctors’ pay. And government analysts and independent experts suggest that although doctors could not absorb a 25 percent fee cut, the claim that they have been inadequately compensated by Medicare until now is wildly exaggerated.

Of course the re-distribution of wealth progressive administration that runs our country today would say its exaggerated.

Among the top points of contention is the complaint by doctors that Medicare’s payment rate has not kept pace with the growing cost of running a medical practice. As measured by the government’s Medicare Economic Index, those expenses rose 18 percent from 2000 to 2008. During the same period, Medicare’s physician fees rose 5 percent.  

Regardless of their motivation, if doctors skew their patient base away from Medicare too drastically seniors’ access to medical care could be limited.

….But the American Medical Association cites a recent online survey that it commissioned in which nearly one-third of primary-care doctors said they are currently restricting the number of Medicare patients in their practice.

Linda Yao, of the District’s Foxhall Internists, has opted for the most extreme response – pulling out of Medicare. The group prides itself on keeping the number of scheduled visits low so that patients who need a last-minute appointment can be accommodated the same day. They also offer half-hour office visits, instead of the 15 minutes on which Medicare reimbursements are predicated. It makes for a white-glove experience for patients, but high overhead for doctors.

After 11 years of serving a patient base of whom as many as half were covered by Medicare, Yao concluded the numbers were no longer adding up. As of April, seniors with Medicare must pay their entire bill out of pocket or through supplemental insurance. So far, only 100 of her approximately 1,750 Medicare patients have elected to stay on.

Could doctors see more Medicare patients if they accepted lower incomes?

Perhaps, said Yao, 42.

But, “the whole system would need to change. … I graduated medical school $100,000 in debt. I worked 110 hours a week during my residency for $30,000 a year and sacrificed all through my 20s. And even now, you’re still seeing people all day, with meetings and paperwork at night, on top of the emotional side of worrying when the patients you care for aren’t doing well. This is life-and-death stuff. And I feel like that should be compensated.”

That’s the “good part” because its going to get a lot worse. Back in April the Actuary’s office  released a detailed report on the bill that was signed by the president, the report signaled an ominous future for medicare patients.

The report projects that Obamacare will drive doctors away from accepting medicare, and would expand insurance coverage to an estimated 34 million people who now lack it creating a demand for services that could be difficult to meet initially and could lead to price-increases, cost-shifting and/or changes in providers’ willingness to treat patients with low-reimbursement health coverage.

The Actuary estimated that within ten years 15% of all medicare providing doctors will become unprofitable as a result of Obamacare’s payment reductions. It also say the Independent Payment Advisory  Board has been given the impossible task of keeping medical costs below medical inflation. Though the report doesn’t officially say this the only way to make up that difference is to limit what is covered through rationing.  Many doctors to quit seeing Medicare patients entirely.

The alternative report says that the number of facilities that would become unprofitable will grow to 25% by 2030 and 40% by 2050 if the health reform law is implemented as written.

Read the full report here