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We May Finally Learn How Many Doctors Are Opting Out Of Medicare

House Speaker John Boehner and House Minority Leader Nancy Pelosi achieved a rare feat of cooperation on Thursday when they corralled their respective parties to fix an entitlement program. The bill changes how physicians are reimbursed under Medicare, the health insurance program for retirees, ending a tiresome ritual requiring Congress to increase the payments every year. It also extends the children’s health program. President Obama has said he is eager to sign the bill if it passes the Senate, which seems increasingly likely.

Buried inside the bill is an important victory for data transparency, one that could help answer a nagging question: Are doctors dropping out of Medicare because of low government payments?

For the first time, the bill will require the government to disclose that dropout rate, which has been the subject of considerable debate.

Physicians’ groups such as the American Medical Association have pointed to the lingering uncertainty each year over the reimbursement rate as a key reason why doctors are increasingly unwilling to accept Medicare patients.

But that claim may be exaggerated, said Jack Hoadley, a health policy analyst with Georgetown University’s Health Policy Institute. Last month, MedPac, an independent agency created to advise Congress on Medicare of which Hoadley is a member, published a report that said it was “rare” for a doctor to opt-out of Medicare, though the numbers might be rising.

This finding is corroborated in a Kaiser Family Foundation report from 2013 which used survey data to show that 96 percent of Medicare beneficiaries had regular access to a doctor’s office or clinic; and often their access was better than individuals with private health insurance. Like the MedPac analysis, this report used one year of (unpublished) data from the federal Centers for Medicare and Medicaid Services to show that only 0.7 percent of physicians opted out of Medicare nationwide.

Cristina Boccuti, a co-author of the Kaiser report, cautioned that “those are national numbers; it doesn’t mean there aren’t some places in the country that might find a higher rate of physicians who aren’t taking Medicare patients.”

Overall, there’s good evidence that claims of doctors ditching Medicare in droves might be exaggerated. We can’t know for sure because the public doesn’t have access to the data. Try to get more than that and you’ll find that is “hard data to find, and we don’t have trend data,” said Boccuti of Kaiser.

The law approved by the House on Thursday is a permanent replacement for an annual ritual, the so-called “doc fix,” that both parties agree is ridiculous. The problem started with the Balanced Budget Act of 1997, which created a badly designed formula that has since required 17 tweaks by Congress to keep reimbursements at a reasonable level. The formula, left unfixed, would require dramatic cuts in how Medicare reimburses doctors, requiring a 21 percent cut on April 1.

Currently, language in the bill requires the Department of Health and Human Services to post the opt-out data online, but that won’t go into effect until February of 2016. But at least the two parties have demonstrated that — however briefly — they can achieve both bipartisanship and transparency.

Andrew Flowers writes about economics and sports for FiveThirtyEight.

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