A year ago, 70 percent of patients at Dr. Rebekah Bernard’s South Florida practice were on Medicare, unsurprising given the relatively large elderly population in her catchment area.
Now, Bernard is unwinding her present business, leaving Medicare behind and opening a direct care practice, where patients pay a monthly fee for what she describes as a higher level of personalized, on-call care.
The Fort Myers-based physician is not alone, growing evidence shows more and more doctors giving up on Medicare, particularly those operating solo or small group practices.
In a survey of primary care physicians who accept Medicare, the Kaiser Family Foundation and Commonwealth Fund found that nearly one in five are not accepting any new Medicare patients.
According to one report -- basing its number on the 1,257 physicians responding to the survey -- that means 200,000 will not accept new Medicare patients. Another survey, published last year by Medscape Medical News, found that 36 percent of physicians believe large numbers of their peers will drop Medicare patients.
“The number-one reason for me opting out of Medicare was, and is, the bureaucracy,” Bernard told Patient Daily. “I just do not feel comfortable working in a system that creates a negative environment and feels punitive.”
The Centers for Medicare and Medicaid is rolling out a new way of reimbursing physicians, from the widely disliked sustainable growth rate to a merit-based system, introduced under the Medical Access and CHIP Re-authorization Act (MACRA).
A final rule on MACRA's implementation was published in October. While this rule attempted to ease the pain of implementation by giving doctors more time to switch, Bernard said that is just “buying time.”
“It is still onerous and there is a lot of responsibility,” she said. “The computer system has to be compliant and that is expensive. It is just too much of a burden.”
Bernard, who was part of a group of doctors that reviewed the new rule, believes the system under MACRA is even more punitive.
“Doctors are trying to do their own job, but also do other non-value-added services and lots of reporting measures,” she said. “There are definitely some doctors who are deciding to opt out of Medicare, others moving to larger group practices. I do know colleagues either leaving or thinking of leaving, or deciding to take early retirement.”
It is likely that large group practices, with a back office or management firm, will increasingly take on a larger share of Medicare patients, according to Bernard. However, that has implications for small towns and rural communities where large practices may not operate.
With her new practice -- which Bernard plans to have fully up and running by July -- patients are billed directly. They pay $100 a month for what she describes as a concierge-like service.
This type of practice is “growing like crazy.” The note transcribing alone takes a fraction of the time she needed to set aside for Medicare patients.
Setting up a new direct care practice will bring pressure, but it is “good pressure because I have more control,” Bernard said.