Trend: Doctors more reluctant to accept Medicare patients

The perfect storm featuring a shortage of primary-care physicians, lower payments to the specialty and a reluctance to take on Medicare patients means the patient log jam at ERs and urgent-care centers may grow as Medicare patients join the uninsured to see physicians.

For example, Arizona officials, especially in the aging Yavapai County's Prescott and Prescott Valley, have noticed the trend of doctors not taking Medicare patients into private practices. The statistics are backed by a June 2008 report from the Medicare Payment Advisory Commission (MedPAC) that says that one-third of Medicare recipients nationwide have trouble finding primary-care physicians.

In most areas of Arizona, the ratio of primary-care doctors to population is below the national average. In several counties, including Yavapai, have ratio is 5.3 primary-care doctors for every 10,000 residents, below the national average of 10.5 per 10,000, according to a December 2009 St. Luke's Health Initiatives report on primary care. The primary-care doctor shortage is growing as younger doctors choose more lucrative specialties, such as orthopedics or cardiology.

The result? A growing number of insured Americans--not just the poor, young and uninsured--may not have a doctor willing to see them. With lower payments (about 20 percent lower than average private payers, according to MedPAC) and more perceived red tape than private-pay patients, a growing number of doctors are wary of Medicare patients.

Medicare payment is based on the Clinton-era funding formula known as the sustainable growth rate. Under the formula, Medicare payments for the typical patient can't exceed the growth of the overall economy. With tough economic times, doctors are facing payment cuts. Congress has halted (temporarily) proposed pay cuts and approved one-year fixes with nominal pay increases, but has yet to fix the funding formula.

MedPAC recommends reforms to the system to aid with care and payment, including the limitations of fee-for-service and a call for greater patient care coordination to maintain patient health. The report also addresses reducing payment to hospitals with higher readmission rates and proposes bundled payments

To learn more:
- read this Arizona Republic article 
- check out the MedPAC report
- read about Medicare's formula for sustainable growth rate
- read about bundled payment options

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