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Ginsburg Cautions Medicare Beneficiary Access to Physicians Slipping
Signs of Physician Capacity Strains Emerging for all Americans; Careful Monitoring Needed
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ASHINGTON, D.C.—Fewer physicians accepting new Medicare patients, longer waits for appointments and physicians working more hours are all telltale signs that Medicare beneficiaries access to physicians is slipping, economist Paul B. Ginsburg, Ph.D, president of the Center for Studying Health System Change (HSC), told Congress Thursday.
"Since the Medicare programs inception, access to care for the elderly has not been a significant issue, but we see warning signs that beneficiaries access to physicians is decreasing," Ginsburg said, adding that the same trends are affecting access for people with private insurance.
Testifying at a House Ways and Means health subcommittee hearing on Medicare physician payment policies, Ginsburg cited preliminary 2001 findings from HSC surveys of consumers and physicians indicating physicians capacity to meet patient demand is tightening. A copy of Ginsburgs testimony is available by clicking here. HSC is a nonpartisan policy research organization funded by The Robert Wood Johnson Foundation.
Physician capacity, or their ability to meet patient demand, depends on a range of factors, including physician supply, the amount of time physicians are willing to devote to patient care, the mix of types of physicians and patients demand for physician services.
The percentage of physicians willing to accept all new Medicare patients has declined by 4 percentage points from 72 percent in 1997 to 68 percent in 2001, according to the HSC Community Tracking Study Physician Survey, a nationally representative survey of about 12,000 physicians.
At the same time, Medicare beneficiaries responding to HSCs Household Survey increasingly have reported problems obtaining physician appointments. In 2001, almost 24 percent of Medicare beneficiaries who reported delaying or not getting needed care said they could not get an appointment soon enough, compared with about 14 percent in 1997.
Medicare beneficiaries also are facing longer waits for physician appointments. About 37 percent of beneficiaries in 2001 reported having to wait more than three weeks for a checkup, up from about 32 percent in 1997. Likewise, more than 40 percent of beneficiaries in 2001 had to wait more than a week for an appointment for a specific illness, up from about 35 percent in 1997.
HSC research also indicates that the average hours per week physicians spent caring for patients increased between 1999 and 2002, rising from about 44 hours a week to 46 hours a week.
"The increase in hours spent in patient care is consistent with anecdotal reports that physicians are working harder to make up for lower fees-either meeting higher demand or creating it," Ginsburg said.
Policy makers also should be mindful of the relationship between Medicare and private insurers physician payment rates, Ginsburg said. HSC site visits to 12 nationally representative communities, ranging from Orange County, Calif., to Boston, have found wide community variation between Medicare physician payment rates and private insurers payment rates.
"The extent to which Medicare patients access to care is compromised by Medicare physician payment cuts will depend on the community where beneficiaries live," Ginsburg said.
Medicare payment methods have strongly influenced private payers, and many health plans set their physician payments as a percentage of what Medicare pays.
For example, in Miami, private payments range from 80 percent to 108 percent of Medicare physician payments. In northern New Jersey, private rates ranged from 95 percent to 105 percent of Medicare payments. In contrast, Boston, Cleveland, Greenville, S.C., Little Rock and Seattle have private rates that are much higher than Medicare. Private payments in Little Rock range from 120 percent to 180 percent of Medicare physician payments and from 100 percent to 150 percent in Boston.
As a result of this community variation, a substantial decline in Medicare physician payments would pose the greatest risk to beneficiaries access in communities, such as Boston and Little Rock, where Medicare payment rates are the lowest relative to private rates. With the potential of "hot spots" of poor access developing in certain communities, new approaches for monitoring access in Medicare may be needed, Ginsburg said.