WASHINGTON — Few Medicare beneficiaries are reporting access problems despite ongoing issues over physician payment, according to surveys released at a meeting of the Medicare Payment Advisory Commission.
In a telephone survey conducted by MedPAC last summer, researchers found that access to physicians for Medicare beneficiaries aged 65 years and over was the same as or better than for privately insured people aged 50–64 years. The survey included responses from 2,000 fee-for-service Medicare beneficiaries and 2,000 privately insured individuals.
The majority of Medicare beneficiaries reported few or no problems with respect to access to physicians in 2004.
According to the survey, 94% of Medicare beneficiaries and 91% of privately insured individuals reported few or no problems accessing care from specialists.
In each group, 88% of the respondents said that they had few problems finding a primary care physician, although both groups reported that they had more difficulty finding a new primary care physician than a specialist.
Access to care is a timely issue, as physicians face 5% annual cuts in their Medicare payments for the following 6 years, starting in 2006, unless a flaw in the reimbursement formula is fixed.
An ongoing concern is that physicians will cut back or cease their care of Medicare beneficiaries if their fees are further reduced.
“The MedPAC survey numbers clearly don't match up with the anecdotal evidence we've been hearing” about physicians scaling back on Medicare patients, said MedPAC Commissioner Alan Nelson, M.D.
“You can stress physicians only to a certain point before they can't take it anymore and start closing practices to Medicare patients,” he said, noting that these survey results show that point has not been reached.
Despite increasing reimbursement concerns, physicians continue to feel a responsibility to care for Medicare patients, he said.
This doesn't mean that physicians can tolerate a 5% cut in 2006 and that the numbers couldn't change overnight.
The findings also don't necessarily reflect what's happening in all areas of the country, he continued. “There may be local areas where physician access problems are more severe than what the national numbers say.”
In other results of the MedPAC survey, the percentage of Medicare beneficiaries who had minor problems finding a primary care physician actually dropped, from 18% in 2003 to 11% in 2004. But in another finding, Medicare beneficiaries listing primary care physician access as a “big” problem increased from 7% to 11% from 2003 to 2004.
“Does this mean we need to be concerned about the primary care physician?” MedPAC Commissioner Nancy-Ann DeParle asked.
MedPAC staffers responded that neither finding signified a specific trend, at least not yet, but that they would continue to track both issues.
On the issue of getting timely appointments, Medicare beneficiaries fared slightly better than the privately insured patients for routine care. And 73% of Medicare beneficiaries and 66% of privately insured individuals reported that they never had to delay an appointment. Only 2% of Medicare beneficiaries and 3% of privately insured individuals reported always experiencing a delay. “As expected for illness or injury, delays were more common for both groups,” said Cristina Boccuti, an analyst at MedPAC who presented the findings at the meeting.
Overall, 6% of Medicare beneficiaries and 11% of privately insured individuals thought they should have seen a doctor for a medical problem in the last year, but didn't.
Within this group, physician availability issues such as finding a doctor or getting an appointment time were the most common responses.
Another survey sponsored by the Centers for Medicare and Medicaid Services reported similar findings on access to care.
In that survey, more than 90% of fee-for-service beneficiaries reported no problems getting a personal physician since joining Medicare, or getting a specialist within 6 months.
The survey focused on Medicare fee-for-service beneficiaries in 11 market areas that were targeted by the 2001 Consumer Assessment of Health Plans-Fee-for-Service Survey as having the highest rates of reported physician access problems. CMS received about 3,300 completed surveys, an agency spokesman said.
“Even in these areas suspected of higher than average access problems, only a small percentage of beneficiaries had access problems attributed to physicians not taking new Medicare patients,” Ms. Boccuti said.
Access problems were more common among transitioning beneficiaries—those new to Medicare or recently disenrolled from the Medicare Advantage Plans, or new to the market area in general. These beneficiaries had more difficulties finding a personal doctor or specialist—“and in some respects that can be expected,” Ms. Boccuti said.
Ability to get timely appointments was a little more problematic in these areas, “but still not bad,” she said.