The pullback in Medicare acceptance is being felt in certain quarters. Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can’t find doctors willing to treat themmainly from affluent urban and suburban areas where many patients can pay out of pocket if their doctor doesn’t accept Medicare. “In most places, doctors can’t pick and choose because Medicare is the biggest game in town, or the only game in town,” he said. Some experts attribute the rise in defections to Medicare payment rates that haven’t kept pace with inflation and the threat of more cuts to come. Under a budgetary formula enacted by Congress in 1997, physicians could see Medicare reimbursements slashed by 25% in 2014 unless Congress intervenes to delay the cuts, which it has done several times. “Medicare has really been pushing its luck with physicians,” said economist Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change. “By allowing the SGR and its temporary fixes to persist, Medicare is risking a backlash by senior citizens who say, ‘Hey, this program isn’t giving me the access to doctors I need.’ .” Some doctors say Medicare’s reimbursement ratesas low as $58 for a 15-minute office visitforce them to see 30 or more patients a day to make ends meet. “Family physicians have been fed up for a long time and it’s getting worse,” said Jeffrey Cain, president of the American Academy of Family Physicians. By disengaging with Medicare and other third-party payers, he says doctors can practice based on what patients need, not what insurers will pay. Other doctors are dropping out of Medicare to avoid deeper government involvement in medicine, much of which is occurring in Medicare. For example, Medicare is now paying incentives to doctors who switch to electronic medical records and who send data on quality measures to the federal government. Doctors who are part of the Medicare program who don’t do so will face penalties starting in 2015.