Despite anecdotal reports that increasing numbers of physicians are dropping out of the Medicare program, the Office of Inspector General has been unable to fulfill its goal of getting at the real numbers and reasons behind the trend. According to a Jan. 26 memo sent to Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, the OIG simply doesn't have access to enough data to conduct a meaningful investigation, Healthcare Finance News reported.

Although CMS provided the OIG with 7,900 providers ranging from 1998 to March 2011, only one out of 10 Medicare Administrative Contractors and one of six legacy carriers provided OIG with all data elements required by CMS. Thus, the OIG said it couldn't sample opted-out physicians to interview, Business Insider reported.

Based on the limited data available, however, the OIG reports that the number of physicians opting out of Medicare appears to have increased each year from 2006 to 2010. The agency warned that if Congress does resolve the sustainable growth rate cuts to Medicare physician payment, more doctors may opt out in the near future.

"Although the percentage of physicians who choose to opt out may be small (perhaps less than 1 percent), monitoring the number of opted-out physicians and their specialties is important to ensure that Medicare beneficiaries have sufficient access to providers, including specialized providers," the OIG stated in its letter to Tavenner. "Additionally, having appropriate data on opted-out physicians is essential to ensuring that such physicians are not inappropriately receiving Medicare payments."

To learn more:
- read the article from Healthcare Finance News
- see the post from Business Insider
- read the memo released by HHS (.pdf)

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