It is difficult to understand why physicians drop out from serving Medicare beneficiaries, says a new report from the HHS Office of the Inspector General (OIG).  The OIG details data limitations encountered when reviewing physicians opting out of Medicare.

An evaluation was launched in April of 2011 to determine reasons for, and the extent of, physicians opting out of the Medicare program. Information sought included characteristics of physicians who opt out of Medicare, i.e., practice type, specialty, and location. The study also sought to identify trends in the quantity of physicians who opt out over time and reasons for their decision. Finally, the evaluation intended to identify effects of such actions on Medicare beneficiaries.

A list of opt-out physicians and non-physician practitioners was acquired during the course of the study from a CMS official. This list was generated by the official using published information found on Medicare Administrative Contractor (MAC) and legacy carrier websites, of which were believed the best source for available data for the purpose of this study. Ten MACs and six legacy carriers that pay Medicare Part B claims were asked to provide information on opt-out physicians for the January 2009 through June 2011 period.

The objectives of the study were not met because:

  • No centralized or complete data source existed, and,
  • Data received were insufficient or not provided at all.

While 2011 guidance issued by CMS addressed procedures for handling opted-out physicians by MACs and legacy carriers, the study recommended further direction to account for comparable data between 1998 and 2008. The evaluation is slated to begin again once a comprehensive data source is available.

To read or download the full report, click here (PDF).