Periodic Contributor

What is AARP position on docs opting out of Medicare

I am astounded by a recent phone call that I made . I tried to get an appointment with an excellent surgeon at a well known hospital. No longer taking Medicare- of any type. This opting out is concerning me. This has occurred just recently to another friend who had orthopedic surgery. Docs opting out totally. Frankly I get it- if they hire their own nurses, ancillary staff, build their own ORs -fine. That’s capitalism-that would be fair. But to use well known hospitals, their staff, their ORs,their beds, the maintenance persons of the hospital where they do the surgery. ….not right. Concierge medicine fine- but don’t then take up the staff of the facilities. Seems to me this business model wants the best of both worlds… the profit with free labor. I’d love to hear anyone’s opinion but especially the opinion of AARP advocacy.

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Regular Contributor

Not just Medicare, it's all in some states: Dr, cert. nurse pract, dental, surgeons, ophthalmologist, allergists, derm, nose & throat, gastro - you name it...due to their own cost of their own medical insurance, quality staff to be hired in their practices, or how treated by their employer, the patients themselves, wages, being far over worked by hospitals without proper supplies ("budget cuts")- staff shortages, better jobs elsewhere, leaving for different medical job, life is too short new location being closer to where their aging parents or grandkids are, etc's are many that I have heard from themselves. Some felt at their age they were being used up after all those years and wanted time-retirement for themselves since they were no longer able to make a difference. 

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Thank you for bringing this question up!! I’d like to know as well!! 

Super Contributor

Why are they opting out?

Social Butterfly

Many services are 'funded' below cost by Medicare.  Private insurers with the same practices might be vulnerable to charges (for instance) of ERISA fraud for the cost shifting of fungible assets that must occur to pretend Medicare is viable. The situation occurs in which Providers can only stay in business and Medicare beneficiaries can only get care on the basis of reducing resources from one  group (that is fully funded) to have enough to care for the short funded group(s). PPACA benefits are funded below Medicare rates in many cases; but that's O.K. because Insurance and Hospitals were indemnified against losses (while Providers were not). "..

Decided April 27, 2020   Maine Community Health Options v. United States, Nos. 18-1023, 18-1028, 18-1038

Today, the Supreme Court held 8-1 that Congress failed to effectively repeal the government’s obligation to make more than $12 billion in payments to insurers under the Patient Protection And Affordable Care Act risk corridors program, and insurers may sue to recover the missed payments. .."  

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Periodic Contributor

Yes,indeed. The Medicare provision is below standard. But oddly the providers opting out do not seem to be the primary care providers! I see this in the field of orthopedic surgery where the providers are not suffering financially. This is just one example. Psychiatrists are opting out-now that I see as financially necessary if in private practice where they don’t use ancillary staff as others’ expense. But extremely wealthy orthos, general surgeons, and neurosurgeons browbeating RN staff is something I am more than familiar with. The concierge or opt outers do not in any way pay for the ancillary services . They do not pay for the service of the PA who follows the patient. In the end though 

I’d bet we both agree that major overhaul is necessary but not at the expense of seniors.

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