October 28, 2011

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

But access is not merely a question of whether a doctor will 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 legitimate question. 

So when doctors respond to Medicare reimbursement uncertainty, exacerbated in the new law, with business decisions likely to impact patients negatively, we should all be concerned about the future of Medicare access beyond the initial question of whether a doctor accepts Medicare payment.

The just-released October 2011 Medical Group Management Association (MGMA) survey about Medicare reimbursement asks its physician members “has the uncertainty created by annual threats of Medicare payment cuts caused your practice to make any of the following business decisions?”[1]

The “yes” response rates are not particularly reassuring.  These changes have already occurred:

                                                                                                                                  Yes

Delayed purchase of new clinical equipment and/or facilities...................64.7%

Reduced staff salaries and/or benefits...........................................................53.4%  

Reduced the number of administrative support staff....................................48.7%

Reduced the number of clinical staff................................................................39.0%

Delayed purchase of electronic health record systems................................31.0%

Delayed the purchase of electronic prescribing technologies.....................23.3%

Closed satellite office(s) (answer if applicable)..............................................23.3%

 

The survey then asks physicians what business decisions they will make if the payments cuts relied upon in the President’s takeover of healthcare law actually happen.

Here too, the “yes” responses are worrisome:

                                                                                                                                  Yes

Delay purchase of new clinical equipment and/or facilities........................68.7%

Reduce staff salaries and/or benefits..............................................................60.7%  

Reduce the number of administrative support staff.......................................56.7%

Reduce the number of clinical staff...................................................................51.0%

Delay purchase of electronic health record systems.....................................30.0%

Delay the purchase of electronic prescribing technologies..........................24.1%

Close satellite office(s) (answer if applicable)................................................ 31.6%

 

Unfortunately, six of these seven business practice questions have higher “yes” responses for delays and reductions which may happen in the future.  Moreover, the survey does not distinguish between respondents; so a physician who has already reduced staff may now intend to reduce staff yet again or a physician who has already reduced staff may now consider delaying the purchase of new clinical equipment.  In any combination, the results do not bode well for the future of Medicare access under current Administration policies.

 

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 President’s government takeover of healthcare law will only make the situation worse.