Opting out of Medicare: Characteristics and differences between optometrists and ophthalmologists

• Published in: PloS one Vol. 19; no. 9; p. e0310140
• Main Authors: Maywood, Michael J, Ahmed, Harris, Parikh, Ravi, Begaj, Tedi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.09.2024
• Subjects: Beneficiaries; Comparative analysis; Cross-Sectional Studies; Data analysis; Data collection; Earth Sciences; Evaluation; Female; Geographical distribution; Government programs; Health care access; Humans; Male; Males; Medical care, Cost of; Medical personnel; Medicare; Medicare - statistics & numerical data; Medicine and Health Sciences; Ophthalmologists; Ophthalmologists - statistics & numerical data; Ophthalmology; Optometrists; Optometrists - statistics & numerical data; Optometry; Optometry - statistics & numerical data; Patients; Pediatrics; People and Places; Physicians; Population studies; Psychiatrists; Reimbursement; Retrospective Studies; Services; Social Sciences; United States; Urban areas; United States; United States > US; Arizona
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0310140

To determine the rate of Medicare opt-out among optometrists and ophthalmologists and to contrast the differences in the characteristics and geographic distribution of these populations. A retrospective cross-sectional study. Using a publicly available Centers for Medicare & Medicaid Services (CMS) data set, we collated data for ophthalmologists and optometrists who opted out in each year between 2005 and 2023. We calculated the rate of opt-out annually in each year window and cumulatively from 2005 to 2023. Comparative analysis was used to identify clinician characteristics associated with opt-out. Both annual and cumulative rate of ophthalmologist and optometrist opt-out from Medicare. The estimated prevalence of Medicare opt-outs was 0.52% (77/14,807) for ophthalmologists and 0.38% (154/40,526) for optometrists. Ophthalmologists opting out were predominantly male (67.5%), had a longer practice duration (average 31.8 years), and were more often located in urban areas (83.1%), compared to optometrists (53.2% male, average 19.6 years in practice, 59.1% in urban areas, p = 0.04, p<0.001, p<0.001 respectively). Approximately 83% of ophthalmologists were either anterior segment or oculoplastics specialties, while the majority (52.1%) of optometrists were in optometry-only practices; >75% of identified clinicians were in private practice. Geographical distribution across the US showed variable opt-out rates, with the top 3 states including Oklahoma (3.4%), Arizona (2.1%), and Kansas (1.6%) for ophthalmology and Idaho (4.3%), Montana (3.1%), and Wyoming (1.4%) for optometry. Few ophthalmologists and optometrists opt-out of Medicare but this trend has significantly increased since 2012. Of those who disenrolled from Medicare, 83% of ophthalmologists were in urbanized areas while 41% of optometrists were in non-urbanized areas. Because reasons for Medicare opt-out cannot be solely determined by administrative data, further investigation is warranted given the potential impact on healthcare accessibility.