Letters to the editor - Brief Article

Healthcare Financial Management, July, 2002

Physicians' Withdrawal from Medicare May Be an Empty Threat

In the article "Killing the Golden Goose? Physicians Exiting Medicare" [HEALTHCARE FINANCIAL MANAGEMENT, May 2002], Jeanne Schulte Scott, JD, writes about physicians dropping out of the Medicare program or limiting the number of patients they will accept. The structure of the Medicare program, however, provides a safety measure against a physician's exit from the program. Physicians get hospital privileges when they agree to abide by hospital rules. Hospitals that want to receive Medicare payments must agree to abide by Medicare rules. A physician who refuses to accept Medicare patients faces expulsion from a hospital.

The physician-patient relationship involves a significant conflict of interest for the physician. When a physician asks a patient to come back for additional examinations or prescribes large quantities of medication for a patient, the question remains whether the physician is doing it for the patient's benefit or his or her own. The physician may be motivated by the desire for more income or protection from malpractice suits, or to look good in the eyes of the pharmaceutical companies.

As long as there are Medicare, Medicaid, Blue Gross, and other payers, we have controls on such conflicts of interest. These payers help ensure that unnecessary services are not furnished. Ms. Scott completed her article with a sentence that should serve as the guiding principle for meeting all such challenges. "A society in which the wealthy have their medical problems addressed and the poor have difficulty obtaining basic services is too harsh, even for us."

Physicians should not even think of withdrawing from Medicare. They should be concerned, as we all should, with seeing that Medicare gives proper payment for services and that our healthcare system takes care of everyone.

Benjamin Podgor

Retired CPA/Attorney

Atlanta, Georgia

The author replies:

While I agree with Mr. Podgor that there are built-in safeguards that could slow the rate at which physicians might withdraw from Medicare, in this era of heavy competition among hospitals, I do not think that hospitals will become the enforcer by throwing physicians who do not participate in Medicare off their medical staffs. And HHS cannot do much either, as long as the nonparticipating physicians abide by the rules. HHS would be able to act only if a nonparticipating physician were to try to charge a Medicare recipient more than the 15 percent cap or refuse to bill the carrier on behalf of the Medicare-eligible patient. No, the only real safeguard is practical economics. Only a certain percentage of physicians can survive economically in the marketplace of Medicare beneficiaries willing to pay the 15 percent addition. The real danger is in the widening breach among the haves, have-somes, and have-nots of health care. Ultimately, that social issue may be resolved as all such social issues are in this countr y, at the ballot box and in the marketplace of ideas.

Jeanne Schulte Scott, JD

Director of Government Relations

NDCHealth Information Services

Washington, D.C.