The Balanced Budget Act of 1997 included a provision which allowed seniors to enter into private contracts with physicians and health care practitioners for services that would not otherwise be covered by Medicare.

But there's a catch. Any doctor or health care provider who wants to set up a contract must sign an affidavit agreeing to stop seeing any Medicare patients for two years. This means that a doctor who wants to enter into one single private contract with one single patient must refrain from accepting ANY Medicare-eligible patients who want to file claims for Medicare coverage.

This has made it more difficult for Medicare patients to find doctors who are willing to treat them. Patients who want to preserve their Medicare coverage are not allowed to pay out of their own pockets for the services they choose.

Talking Points:

• Doctors agreeing to treat Medicare patients under private contracts should not be penalized from participating in the Medicare program.
• It is the choice of the patient, not the government, to decide which physician best serves that patient. A patient may want private contracts for some services, and coverage for others.
• The Medicare program and CMS need to make physician participation in Medicare more attractive, no less accessible to physicians within and outside Medicare.
• A recent DPMA survey of Ohio physicians found that 65.6% would be more willing to treat Medicare patients if they were allowed to engage in private contracts with some of those patients instead of the mandate to file a claim.
• The same DPMA survey in Ohio found that 46% of physicians would be willing, or even prefer to treat some Medicaid or Medicare-eligible patients for free rather than file a claim for payment.
• Physicians are reluctant to treat Medicare patients due to "government interference," according to an Association of American Physicians and Surgeons (AAPS) survey. Thirty-three percent do NOT accept new Medicare patients, and 40% restrict the types of services. REIMBURSEMENT RATES ARE THE LEAST CITED REASON.
• The same survey shows that 63% would be more willing to serve Medicare patients if unrestricted private contracting were allowed.
• Another finding: physicians are more willing to treat patients for FREE rather than accept them as Medicare patients.