The Nashville neurologist's costs had risen even as revenues had fallen 40 percent from the past decade.
"They were paying less and less for what we were doing," Bachrach said.
Uncertainty about reimbursements from payers, including Medicare and private insurers, is a lingering issue for many doctors. They face a 21 percent overall cut in Medicare reimbursements that becomes effective today. It could still be averted by a monthlong stay that the U.S. House passed on Thursday; action is pending in the Senate. Many doctors, meanwhile, are holding out hope for a "permanent fix" to how physicians are paid.
In the interim, more doctor practices are considering not accepting new Medicare patients. Many other doctors are seeking employment at hospitals. And others are focusing more on patients who pay out of pocket and ending ties with insurers that cut rates.
If the Senate passes the temporary fix that's expected to stave off the 21 percent cut, it would be the latest in a series of patches that have become a near-annual ritual in Congress since 2003.
Under the formula by which doctors are paid by Medicare, growth in total payments to physicians can't exceed annual growth in the nation's gross domestic product. As the U.S. population ages, doctors are serving more patients, and they're using more costly treatments and tests amid advances in technology. As a result, doctors are requesting reimbursements that exceed GDP growth, which has averaged about 3 percent. Medicare is required to ensure that total payments don't exceed budget.
Lobbyists for doctors, including their trade group American Medical Association, have played the lead role in persuading Congress to keep the rate cuts from going into effect.
If the rate cut goes into effect, doctors will feel the impact beyond Medicare. Many private insurers factor the Medicare rate into setting their own rates.
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