Article Date: 3/1/2001

Medicare Spurned
Frustrated doctors have been turning away Medicare patients. Have you had enough?
From the Executive Editor, Larisa Hubbs

Late last month, I read something interesting -- and disturbing -- in USA Today about the sad state of Medicare and how, in some cases, poor reimbursement from this plan is forcing doctors to make tough decisions.

Happy birthday, seniors

Although this isn't cause for much celebration for those facing their 65th birthdays, I can certainly empathize with doctors.

One doctor in the USA Today article said that his Colorado-based group practice loses about $100 per Medicare patient each year.

In fact, the article focused mostly on doctors and patients in Colorado. Apparently, this state has one of the lowest Medicare reimbursement levels, frequently at levels 20% below the highest paid areas. However, the article also noted that patients in other areas of the country also have been affected.

Widespread participation

Are these isolated incidents -- or the start of a growing trend?

Presently, most doctors in the nation still participate in Medicare. The government plan covers 39 million disabled and elderly patients at an annual cost of $212 billion.

A quick look at the number of O.D.s who participate in Medicare fee-for-service (traditional) plans reveals that, on average, about 15% of O.D.s' patients are covered this way. Another 3% of O.D.s' patients are covered under Medicare HMO plans. (These percentages were highlighted in the AOA's "2000 Third Party/Managed Care Survey.")

The survey also noted that for O.D.s located in the West North Central and East South Central regions, Medicare was an important source of revenue -- even more so than Vision Service Plan.

Has optometry been affected?

"I haven't heard anything from O.D.s about this situation," commented Jeff Mays, director of the AOA's Washington office, "and we have some fairly active members in Colorado.

"Really, the only thing we've been hearing is the age-old battle of whether Medicare is treating optometry fairly as far as participation or reimbursement," he added.

Maybe it's too soon for this trend to have an effect on O.D.s; or possibly, with only about 15% of O.D.s' patients covered under traditional Medicare plans, this trend might not have the impact on O.D.s that it's having on M.D.s. Time will tell. 

(If you've felt the sting of this trend, I'd like to hear about it. Please e-mail your thoughts to me at

Optometric Management, Issue: March 2001