Older patients have been forced to reconcile with their primary care doctors no longer accepting Medicare and finding a new doctor they can afford. This comes as a serious loss to Medicare beneficiaries as it results in a loss of a patient/doctor relationship and financial security.
Doctors have complained for some time now that Medicare does not reimburse them adequately or in a timely manner, and also, that it requires too much tedious paperwork to get paid. Many Medicare beneficiaries are being told that their primary care doctors are no longer taking Medicare, and are experimenting with alternative payment methods, such as concierge medicine. This payment method requires patients to pay upfront to retain the doctor. Many patients cannot afford this arrangement, and as a result, have been forced to find a new primary care physician.
Alternate payment plans: Concierge model
Health experts are unsure of the exact number of physicians who work with concierge practices. The American Academy of Family Physicians (AAFP) estimates that fewer than three percent of their 134,000 members use this model, but that number is slowly growing.
One physician consulting company, Concierge Choice Physicians, estimates that roughly 10,000 doctors practice some form of membership medicine, although it may not strictly apply to Medicare patients.
The concierge medicine option may only be prevalent in wealthier areas.
“Doctors switching to other payment systems or those charging Medicare patients a higher price for care are likely in more affluent, well-to-do areas where, frankly, they can get fees,” said Travis Singleton, executive VP for the medical staffing company, Merritt Hawkins.
It is far easier for physicians than hospitals to opt out of taking Medicare patients. Most hospitals have to accept them since they rely on Medicare payments to fund inpatient stays, doctor training, and other functions.
The majority of physicians still accept Medicare, and most people insured by the federal program for seniors and people with disabilities have no problem finding another healthcare provider. But that transition can be tough, particularly for older adults with multiple medical conditions.
Creative business models can make up that difference. Under the concierge model, the doctor charges patients an annual fee, much like a subscription, to access their practice. In addition, your provider still bills the insurer, including Medicare, for all patient care.
Direct primary care
Another payment option older adults are resorting to is direct primary care. This model only charges the patient an annual fee for access and care. This way doctors can bypass billing health insurance plans all together.
Proponents say that the model enables them to take more time with their patients without dealing with the bureaucracy of getting paid by health insurers.
“I think what is most attractive to direct primary care is that they just practice medicine,” said Shawn Martin, senior vice president of the AAFP.
“The size of a physician practice can also determine whether it accepts Medicare. Large practices can better offset the lower Medicare payment rates by leveraging their influence with private insurers to raise those reimbursements. But small, independent clinics may not have the same clout,” said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy.
“If you’re a large primary care practice, private insurers are really going to want to have you in their network,” he said. “And they’re willing to pay more than they might pay an individual solo practitioner who they’re not as concerned [with] because it’s only one physician.”
After seven years, Betsy Carrier, 71, and her husband, Don Resnikoff, 79, of Montgomery County, Maryland, were surprised when their primary care doctor informed them she was opting out of Medicare.
Luckily, after more than a dozen calls to physicians, Carrier and Resnikoff said they found another primary care doctor. They said their new doctor accepts Medicare and impressed them during their meet-and-greet with her knowledge of their medical history. She also met their criteria for age and expertise.
“At this point in our lives, I’d be eager to find somebody who’s young enough that they might be in practice for the next 10 years,” Carrier said.
Heightened risk of mishaps
“When transition of care happens, from one provider to another, that trust is often lost and it takes time to build that trust again,” said Dr. Fatima Sheikh, a geriatrician and the chief medical officer of FutureCare, which operates 15 rehabilitation and skilled nursing centers in Maryland.
Shuffling doctors also heightens the risk of mishaps.
A 2016 study of at least 2,200 older adults published in 2016 found that nearly four in 10 were taking at least five medications at the same time. Fifteen percent of them were at risk of drug-to-drug interaction.
“Primary care providers mitigate this risk by coordinating among doctors on behalf of the patient,” said Dr. Kellie Flood, a geriatrician at the University of Alabama-Birmingham.
“You really need the primary care physicians to serve as the quarterback of the healthcare team,” said Flood. “If that’s suddenly lost, there’s really not a written document that can sum all that up and just be sent to the new doctor.”
Medicare beneficiaries outweigh available doctors
The immense amount of seniors who qualify for Medicare has outpaced the number of doctors available to treat them. According to the Census Bureau an estimated 10,000 Americans turn 65 and become eligible for the government program every day.
In 2010, Medicare Payment Advisory Commission (MedPAC) reported there were 3.8 primary care doctors for every 1,000 Medicare enrollees. In 2017, it decreased to 3.5.
Another MedPAC report from 2019 suggested that the number of available primary care providers could actually be overestimated. The data was collected and calculated under the assumption that all internal medicine doctors provided services for all Medicare patients. In reality, many specialize in certain medical conditions, and/or accept only a limited number of Medicare patients.
MedPAC researchers concluded, “We found that beneficiaries have access to clinician services that are largely comparable with (or in some cases better) access for privately insured individuals, although a small number of beneficiaries report problems finding a new primary care doctor.”