Factors Associated with Psychiatrist Opt-out from US Medicare: an Observational Study
Concerns exist about availability and access to psychiatric services in the USA. For Medicare beneficiaries, one impediment to psychiatric services is the extent to which psychiatrists have opted out of the Medicare program.
This study describes geographic variation in rates that psychiatrists opt out of Medicare, and assesses physician-level and geographic-level predictors of opt-out.
Retrospective cross-sectional analysis of data describing psychiatrists’ opt-out status as of March 2017 linked to data on psychiatrist location, psychiatrist characteristics (obtained from a comprehensive US physician database), and market area–level characteristics.
27,838 psychiatrists in the USA
Whether a psychiatrist had opted out of Medicare as of March 2017.
Overall, 7.0% of psychiatrists (1940/27,838) opted out of Medicare as of March 2017. Opt-out rates varied substantially across states and within states. Physician-level factors independently associated with opt-out included: older age (psychiatrists > 65 years were 2.6 percentage points more likely to opt vs. psychiatrists < 35 years old, p = 0.03), greater years of experience, female gender (female psychiatrists were 2.6 percentage points more likely to opt out than male psychiatrists, p < 0.001), graduation from a top-20 ranked medical school (1.7 percentage points more likely to opt out of Medicare, p < 0.001), and domestic medical graduate (domestic graduates were 7.3 percentage points more likely to opt out of Medicare vs. foreign graduates, p < 0.001). Adjusting for other individual- and geographic-level factors, psychiatrists who practiced in areas with more psychiatrists per Medicare beneficiary were less likely to opt out (p < 0.001).
The overall likelihood that psychiatrists opt out of Medicare is significant and varies considerably across regions and by characteristics of psychiatrists.
KEY WORDSpsychiatry Medicare workforce access to care
Dr. Jena received support from the Office of the Director, National Institutes of Health (DP5OD017897).
Compliance with Ethical Standards
The study was approved as exempt from review by the institutional review board of the University of Minnesota.
Conflict of Interest
Dr. Jena received support from the Office of the Director, National Institutes of Health (DP5OD017897), and has received consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group; Dr. Karaca Mandic received no support from any organization for the submitted work, and provides consulting services to Precision Health Economics that have no relation to this manuscript; all remaining authors declare that they do not have a conflict of interest.
- 4.Medicare Improvements for Patients and Providers Act of 2008. in 122 STAT 24942008.Google Scholar
- 6.Bocutti C, Neuman P. Private Contracts Between Doctors and Medicare Patients: Key Questions and Implications of Proposed Policy Changes. Kaiser Family Foundation; 2017.Google Scholar
- 7.Medicare Payment Advisory Commision: March 2017 Report to the Congress: Medicare Payment Policy. 2017.Google Scholar
- 8.Centers for Medicare and Medicaid Services: Medicare Individual Provider List. 2017.Google Scholar
- 13.Centers for Medicare and Medicaid Services: Medicare Provider Enrollment, Chain, and Ownership System (PECOS). 2017.Google Scholar
- 16.US News and World Report: Best Medical Schools: Research. 2017.Google Scholar
- 17.Health Resources and Services Administration: Primary Care Service Area Data Download - 2010. U.S. Department of Health and Human Services; 2013.Google Scholar
- 18.Centers for Medicare and Medicaid Services: Public Use File. 2017.Google Scholar
- 19.US Census Bureau: American Community Survey. 2017.Google Scholar
- 20.Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. 3. College Station, Stata Press; 2012.Google Scholar
- 25.Heisler EJ. The Mental Health Workforce: A Primer. Congressional Research Service; 2018.Google Scholar
- 26.National Resident Matching Program: National Resident Matching Program, Results and Data: 2018 Maid Residency Match. Washington, DC2018.Google Scholar