July 8, 2011

Access for Medicare beneficiaries is already a problem certain to worsen without action to address significant physician payment cuts relied upon in the Democrats’ takeover of healthcare law.

A recent survey of doctors reveals nearly a third of primary care physicians restrict the number of Medicare patients in their practice mainly on account of low and unreliable government payment.[1] 

The American Academy of Family Physicians reports that more than 12 percent of its doctors simply don’t accept Medicare patients, up from 8 percent in 2008 and 6 percent in 2004.[2]

And of the 60 percent of doctors in a recent Physicians Foundation survey who said health reform will compel them to close or significantly restrict their practices, 87 percent said they would close or significantly restrict their practices to Medicare patients.[3]

But access is not merely a question of will a doctor accept or continue to see a patient.  Access encompasses as well the quality of a patient visit and the doctor-patient relationship generally. “Access to what?” is a genuine question. 

So when doctors respond to Medicare reimbursement uncertainty, exacerbated in the Democrats’ takeover of healthcare law, with business decisions likely to impacts patients negatively, experts are concerned about the future of Medicare access beyond the threshold question of whether a doctor accepts Medicare payment.

The most recent Medical Group Management Association (MGMA) survey about Medicare reimbursement asks its physician members “which business operation considerations are currently under discussion by your practice due to this [Medicare] reimbursement uncertainty?”[4]

The “yes” response rates are not particularly reassuring…for anyone on the receiving end of a doctor visit:

Reduce the number of administrative support staff                        60.5%

Reduce the number of clinical staff                                                    54.0%

Delay increase in physician salaries and/or benefits                     71.6%

Delay increase is staff salaries and/or benefits                               79.1%

Delay purchase of electronic health record systems                       45.3%

Delay purchase of electronic prescribing technologies                  42.4%

Delay purchase of new clinical equipment and/or facilities            76.6%

These responses are consistent with further Physician Foundation survey findings: Over two-thirds of doctors (68 percent) believe the Democrats’ healthcare law will reduce the financial viability of their practices; 59 percent believe health reform will result in less time with patients; and 56 percent said reform will diminish quality of care.[5]

Both MGMA and the Physicians Foundation may conduct similar surveys later this year.   The numbers will likely change for the worse if nothing is done to address the multiple threats to Medicare access in the President’s healthcare overhaul.

Key Take-Aways   Medicare “access” encompasses quality of care and the doctor-patient relationship generally. Medicare reimbursement uncertainty is prompting doctors to “reduce” and “delay” investment in their practices. Payment cuts to doctors relied upon in the Democrats’ healthcare law will only make the situation worse.