Medicare hassles push doctors to consider opting out

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With the U.S. Congress looking for ways to trim growing entitlement expenditures, the bloom is not only off the rose of Medicare, the stench of decay is permeating doctors' waiting rooms.

Unless lawmakers act before the end of the year, doctor reimbursements are scheduled to be reduced even as providers complain current reimbursement rates don't cover the cost of care.

The result: Many doctors are declining to take on new Medicare patients and many are thinking about disenrolling in the system, reports the Association of American Physicians and Surgeons, which has historically opposed Medicare.

"Disenrollment is a way to evict occupiers from doctors' offices and the patient-physician relationship," suggests Dr. Jane M. Orient, the association's executive director. "Occupiers include bureaucrats, bounty-hunting auditors, federal prosecutors waiting for doctors to trip up on complex rules -- and AMA [American Medical Association] officials and committees who make up complicated codes and dictate the 'relative value' of all covered services."

Medicare was created in 1966, part of President Lyndon Johnson's Great Society reforms. It was supposed to protect seniors, who are automatically enrolled in Part A when they turn 65, from devastating hospital bills. Part B physician coverage is optional.

Initially to entice medical establishment participation, the government automatically enrolled doctors to participate. The idea was attractive. No longer would doctors have to chase patients for payment. Now it appears, the system has come full circle -- only this time the doctors are chasing the government. And since 1996, the system has been larded with new requirements that have increased bureaucratic hassles and imposed greater costs on providers for everything from enrolling in the system to billing procedures, the association said. Those doctors who wish not to participate in the program need to opt out every two years.

Medicare spent $528 billion in 2010 and that figure is expected to grow exponentially as more baby boomers move into their golden years. In fighting President Obama's healthcare reform, Republicans raised the specter of death panels deciding whether it was worth providing coverage for procedures that may only extend a patient's life for a short time. Earlier this year, Rep. Paul Ryan, R-Wis., proposed dismantling the system and giving seniors vouchers that would allow them to find their own medical coverage -- a proposal decried by Democrats as an attempt to throw Granny under the bus.

"As far as we can determine, there is no law expressly forbidding Americans to spend their own money for life-saving medical treatment if they sign up for Medicare Part B," Orient said. It's a matter of paying the doctor directly and then filling out a form for reimbursement.

"Under the U.S. Constitution, Congress has no express authority to compel physicians to enroll in a government program in order to serve their patients, or to regulate the practice of medicine," she said in an article published in the winter issue of the Journal of American Physicians and Surgeons.

In a separate article, attorney Andrew L. Schlafly, wrote the federal government has exerted immense financial pressure on the medical establishment through Medicare.

"Even before passage of the Patient Protection and Affordable Care Act, more commonly known as 'Obamacare,' the federal share of dollars spent on medical care has been sharply increasing," Schlafly said. "For example, federal healthcare expenditures jumped from 24 percent to 27 percent of the total in merely one year, between 2008 and 2009. Meanwhile, the state and local shares of total medical spending actually declined from 17 percent to 16 percent during that same period."

Whether or not doctors can be forced to participate in Medicare may be decided as last year's healthcare reform bill works its way through the courts.

"Formally opting out of Medicare has grown in popularity. But a tantalizing alternative approach is emerging: disenrolling from Medicare altogether," Schlafly wrote. "We are unaware of a court case establishing or forbidding this option. Government may prefer not to test its authority over disenrolled physicians rather than risk a new precedent against its power.

"A consequence of the 'Obamacare' litigation may be to resolve this issue too. If 'Obamacare' is invalidated for going beyond the constitutional authority of the federal government, then that precedent may also limit federal authority over private contracts with disenrolled physicians."