After 7,400 physicians submitted paperwork to opt-out of medicare in 2016, the number cut in half last year, according to new data from the Centers for Medicare and Medicaid Services. The entirely reasonable explanation cited in this Modern Healthcare piece attributes the decrease to the end of a stipulation that required providers to renew their opt-outs every two years. The renewal requirement went away—you guessed it—two years ago, hence the drop now.
But whether the trend is more about paperwork than anything else, the news did get me thinking about how many doctors in Dallas choose to opt-out of Medicare. So, I decided to take a look.
First, a word about why the opt-outs have seen—2017 notwithstanding—such a spike in recent years. Opting out means that doctors aren’t subject to Medicare’s rules, which limits what they can charge. In 2011, there were hardly any doctors choosing not to participate. But according to Modern Healthcare, the opt-outs have risen as the program’s reimbursements have failed to keep up with the costs of healthcare in today’s age. More:
Medicare remains a vital part of many doctor practices. But some clinicians, particularly in wealthy metropolitan areas, feel they can opt out of the program because they can fill their practice with patients who have commercial insurance or are willing to pay out-of-pocket for care, according to Dr. Charles Rothberg, president of the Medical Society of the State of New York.
Rothberg would know, as his state sees the second-most opt-outs of any, right behind California. Texas falls in at number three.
Slicing into CMS’ data a little further, we get a view of our region specifically. Dallas physicians have filed a combined 169 Medicare opt-out affidavits. Like the rest of the country, Dallas peaked in 2016—with 55. Last year, 22 were filed.
You might expect that the lion’s share of these physicians would be speckled among clinics in the heart of Dallas, within affluent patches like Highland Park or Uptown. When we drill down another step, though, we can see that the thickest density of opt-out doctors are actually located in the 75230 and 75231 zip codes, which check out to North Dallas, Vickery Meadow, and a slice of Preston Hollow. The 75230-based Cooper Clinic has more than 20 opt-outs by itself.
In Texas, only Houston (191) has more opt-outs than Dallas (169), and Plano (47), Fort Worth (40), Arlington (34), and Frisco (21) each register among the top 10 Texas cities for opt-outs, as well. As reimbursements have fallen, it appears many North Texas doctors have chosen to say goodbye to treating patients under Medicare.