services. But each time Congress fails to repeal the SGR and replace it with a more sensible system, the cuts grow, and the cost of fixing the problem compounds. “I thought this was the year we would get there because for the first time the cost to correct the situation decreased. That alone should have been enough incentive for Congress to go ahead while we can to correct it,” Dr. King said. But Congress has used a Band-Aid approach for so long, the Abilene otolaryngologist worries the damage may be done as the problem continues to chase doctors out of the Medicare program. He is among the roughly 40 percent of Texas physi- cians restricting the number of new Medicare patients they see because of the unpredictability. In fact, the percentage of Texas physicians accepting all new Medicare patients dropped from 78 percent in 2000 to only 59 percent in 2012, according to TMA’s latest survey.
Some physicians — and their patients — don’t have that choice, Dr. King says, particularly in rural areas. Chad White, MD, is one of just two family physicians in rural Hamlin. With 60 percent of his patients in Medicare, “we depend on these payments. This is who I serve. This is where I live. And these are my patients,” many of whom drive 45 minutes to see him because their doctors in nearby towns left the program.
Meanwhile, the other Hamlin doctor nears retirement. “I can’t do this by myself. But it’s hard to bring people to these areas and for me to continue practicing without enough reimbursement to make a living,” Dr. White said. And at a time when the health care delivery system focuses
on reform, Dr. Hoven adds that Medicare pay instability holds back physicians from implementing practice changes to im- prove quality of care for patients. “How can physicians have
Medicare: in or out?
Medicare payment uncertainty means physicians have decisions to make about their participation in the program. You have three options:
• Participation (PAR): This means you agree to provide all covered services for all Medicare Part B beneficiaries on an assigned basis and accept the Medicare-approved amount as payment in full. Medicare pays you directly.
• Non-participation (Non-PAR): This means you have not entered into an agreement to accept assignment on all Medicare claims, so you can choose whether to do so on a claim-by-claim basis. Payment is 5 percent less than the PAR amount. On unassigned claims, Medicare pays the patient, and you collect from the patient.
• Opt-out: This means you privately contract, in writing, with Medicare patients on fees and services. Except in certain emergency situations, Medicare will not cover your services and will neither pay you nor reimburse the patient. If done properly, your opt-out status lasts two years.
TMA recommends you evaluate your Medicare participation status each year. If you want to
make changes, you must fill out certain forms to notify Medicare of your decision during the an- nual open enrollment process, which usually occurs at the end of each calendar year. Participation decisions are effective Jan. 1 of each year. As soon as Medicare makes the 2015 enrollment deadlines available, TMA will notify you through
the association’s online Action and TMA Practice E-tips newsletters. Subscribe by visiting www.tex
med.org/TMA_Publications_Listing.aspx. And for more information on all things Medicare, includ- ing enrollment, payment, and coding, you can also consult TMA’s Medicare Resource Center online at
www.texmed.org/Medicare. Or contact the TMA Knowledge Center at
knowledge@texmed.org or (800) 880-7955.
26 TEXAS MEDICINE June 2014
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