May 11, 2012

Key Take-Aways

• Medicare access challenges will persist throughout 2012 because of looming reimbursement cuts.
• The president’s government takeover of health care law fails to address the Medicare “doc fix” reimbursement issue.
• The house-approved budget takes on the “doc fix” issue by proposing a ten-year deficit neutral reserve fund, protecting access to care without adding to the nation’s debt.

Medicare reimbursement for physician services remains a frustration for doctors that likely will result in additional access challenges for beneficiaries as 2013 approaches.  The most recent “doc fix” stabilized rates only through the end of 2012 and doctors are already responding to the uncertainty over what is to come.  Absent yet another temporary patch or a more permanent solution, doctors are facing an approximately 32 percent reimbursement cut on January 1st.

“Disgruntled is probably just too soft of a term for this,” says Robert Wah, Chairman of the Board of Trustees of the American Medical Association in a recent NPR story.   “Many physicians are also small businesses.  So the uncertainty of knowing how much – or in some cases whether they’re going to be paid to see their Medicare patients, is more than just an inconvenience” according to the article.  Dr. Wah elaborates “‘because they have to continue to pay their rent and their insurance and their electric bill and the salaries of people that work in their office…it’s really devastating to try to run an office in this environment.”’

The NPR story points out (as described in recent editions of Medicare on Main Street, e.g., here and here) that Medicare access challenges are most acute for beneficiaries trying to change doctors.  This is so because a common action physicians take to limit their Medicare exposure is to no longer accept new patients even if they continue to treat their current Medicare patients and those clients who eventually age into Medicare. 

Another story in the Bellingham Herald just this week drives home the message.  The story points out that of approximately 150 primary care physicians in Whatcom County, WA for 32,000 Medicare beneficiaries, less than 25 percent accept fee-for-service Medicare.  “For patients with Medicare,” the story explains, “finding a doctor means calling a list of providers to learn who is accepting new Medicare patients and which Medicare plans they accept.  It can also mean putting your name on a waiting list until space becomes available.”   Whitney Jagich, a counselor at Whatcom Alliance for Healthcare Access observes, “‘[seniors] need encouragement to keep trying to find a primary care practitioner, because they’re definitely encountering barriers to receiving the care they need.’”  The story describes this challenge ultimately as a question of dollars and cents.  “‘Whatcom physicians want to be able to treat these patients but economically they can only see a certain number before they can no longer sustain their businesses,’” says Christopher Key, executive director of the Whatcom County Medical Society.  “‘A fairly limited number of physicians and groups accept [Medicare] to start with…Some don’t want to deal with it at all and won’t accept Medicare under any conditions.’”  Many of the calls to the Whatcom Medical Society are from people who have seen their family doctor for years.  “Then, when they turn 65 and find themselves on Medicare, they learn that their relationship with their physician is severed because they can’t or won’t accept Medicare.”

As January draws closer, we can expect to see survey results as least as worrisome as the most recent numbers from the Medical Group Management Association (MGMA) 2011 survey which asked doctors how they would respond to looming payment cuts relied upon in the president’s government takeover of healthcare law:

The “yes” and “uncertain” response rates to this question should be troubling to policymakers and, of course, to beneficiaries.  Of particular interest:  more than half of respondents suggest they are considering “opting-out” of Medicare altogether.    

                                                                                                                          Yes                   Uncertain

Reduce the number of appointments for new Medicare patients       51.0%               33.1%

Reduce the number of appointments for current Medicare patients  34.8%               35.0%

Stop accepting new Medicare patients                                                     30.9%               45.0%

Only accept established patients aging into Medicare                          26.9%               47.4%

Cease treating all Medicare patients                                                          9.0%                44.4%

These responses are consistent with further Physician Foundation survey findings wherein 60% of doctors said that “health reform” will compel them to close or significantly restrict practices to certain categories of patients.  Eighty-seven percent of the 60% (52% overall) said they would close or significantly restrict their practices to Medicare patients.  Moreover, 93% of these doctors (56% overall) said they would close or significantly reduce their practices to Medicaid patients.  This certainly does not bode well for future Medicare access under the current administration. 

Unfortunately, the president’s government takeover of healthcare law doesn’t address this critical issue for America’s seniors anywhere in its 2,700 pages.  The House-approved budget, however, recommends a ten-year “doc fix” in the form of a deficit-neutral reserve fund. Washington must stop spending money it doesn’t have, and this proposal ensures doctors do not experience sharp reductions in their Medicare reimbursement rates – protecting seniors’ access to critical care – without adding to the nation’s debt.

Dr. Mark McClellan, former CMS Administrator and FDA Commissioner, and now Director of the Engelberg Center for Health Care Reform at Brookings, comments on the ongoing toll the doc fix issue is taking and related access for Medicare beneficiaries:

"Physicians can't easily plan ahead because the future of their payments is unclear, and many are wondering about how long they will be able to keep serving seniors."