According to the latest Medscape Physician Compensation Report, 7% of doctors are not accepting new-patient visits from Medicare beneficiaries. Another 4% will stop treating some or all of their current Medicare patients, and will no longer take on new ones. A surprising 16% of providers surveyed said that they are still deciding about taking on and treating new Medicare and Medicaid patients. Is this a new trend? In this blog, we review the Medscape Physician Compensation Report 2018 and examine its implications for physicians dealing with Medicare.
Do All Doctors Accept Medicare in 2018?
For many providers and practices, Medicare beneficiaries make up the most significant percentage of their patient population. As such, it is difficult to imagine doctors not accepting Medicare patients, but the results of the survey show that for many, this is a genuine possibility in the near future. According to the reports, “Many physicians have opted out of Medicare… due to the low reimbursement rates and the amounts of paperwork and reporting requirements necessary.”
However, this information seems to contradict another trend that the report highlighted. An eye-catching statistic from the report is the answer to the question, “will you drop insurers that pay poorly?” A little over 80% stated that no, they would not drop insurers that paid poorly. Of these, 22% said they need all payors, 24% said that it is inappropriate, and 35% said no for other reasons.
So, the question is: if so many doctors will not drop a payor due to low reimbursement, what is causing them to rethink their relationship with Medicare? What is the driver behind the thinking of doctors not accepting Medicare patients?
Quality of Care and the Quality Payment Program (QPP)
The answer may be the recent increase in time devoted to paperwork and other administrative tasks. The report states, “over a third (of physicians) spend 10 – 19 hours a week on paperwork. In total, almost three fourths (70%) of physicians spend more than 10 hours per week on paperwork and administrative tasks. In 2017, it was 57%.” Some of the physicians in the study report the jump in paperwork is due to the burdens of reimbursement based on quality of care.
For many clinicians, this is where the administrative burden of working with Medicare comes into play. 2018 will mark the second year of the Quality Payment Program (QPP), put in place by the Centers for Medicare and Medicaid Services on January 1, 2017. QPP aims able to reward high-value, high-quality Medicare clinicians with payment increases, while at the same time reducing payments to those clinicians who aren’t meeting performance standards. To participate in the QPP program and avoid a future reduction in payments, physicians must submit data that will ultimately determine reimbursement based on quality of care.
The required data is driven by documentation, which is the healthcare provider’s responsibility. In some cases, physicians not only need to be more specific in their visit notes, which requires more time, but they must also make sure they are using established rubrics to support their medical decision-making. The main objective of these activities is to deliver the best care possible and make sure that physicians with excellent outcomes receive reimbursement based on quality of care, which will benefit them. There is little doubt, however, that the drive toward reimbursement based on quality of care has increased paperwork substantially.
So, where will we go from here? Will the administrative burdens of reimbursement based on quality of care cause an increase in doctors not accepting Medicare patients? Only time will tell if the incidence of doctors no longer accepting Medicare patients becomes an ongoing trend.
If you are interested in reading more about the Medscape survey, you can find the overview here