Lack of data regarding doctors leaving Medicare

Anecdotally, it is believed within the healthcare community that doctors are leaving Medicare in greater and greater numbers. A new report by the Office of Inspector General has found that there is not enough data available to make any determinations about this trend.

In a memorandum report sent to Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, Stuart Wright, the OIG’s deputy inspector general for evaluation and inspections said that the OIG attempted to conduct a full evaluation of physicians who have opted out of Medicare but were unable to complete that evaluation because of limited data.

“In the course of our review, we determined that the Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractors (MACs) and legacy carriers (i.e., Medicare claims payment contractors) do not maintain sufficient data regarding physicians who opt out of Medicare. As a result, we are unable to conduct the proposed evaluation at this time,” said the OIG’s letter to Tavenner.

The OIG began its evaluation last spring, intending to determine how many doctors were opting out of Medicare, why these doctors were leaving and what effects their leaving were having on patients.

The OIG did note that based on the limited data it was working with, it appears that the number of physicians opting out of Medicare has increased each year from 2006 to 2010. The agency warned that if Congress does not intervene to resolve the sustainable growth rate cuts to Medicare physician payment, more doctors may opt out in the near future.

“Although the percentage of physicians who choose to opt out may be small (perhaps less than 1 percent), monitoring the number of opted-out physicians and their specialties is important to ensure that Medicare beneficiaries have sufficient access to providers, including specialized providers,” the OIG stated in its letter to Tavenner. “Additionally, having appropriate data on opted-out physicians is essential to ensuring that such physicians are not inappropriately receiving Medicare payments.”

The OIG offered CMS no recommendations in its report but did stress that the quality of the data and lack of procedures impedes CMS’ oversight of this part of the Medicare program.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.

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