Falling Medicare reimbursement crimps access

OB/GYN News, June 1, 2002 by Jennifer Silverman

The recent 5.4% decrease in Medicare reimbursement rates has started to take its toll on access to health care.

In Washington state, Medicare beneficiaries are finding it increasingly difficult to see a primary care physician or get a referral to a specialist. In a recent poll conducted by the Washington State Medical Association, 57% of physicians surveyed were either limiting Medicare patients or dropping all of their Medicare patients.

Of 194 medical practices representing 325 physicians statewide, almost half--88 practices--said they weren't raking new Medicare patients; 23 practices said they were dropping all Medicare patients, and 83 practices were making no changes. These statistics appeared in the association's report "Washington's Ailing Health Care System: Continued Decline, Guarded Prognosis."

"Increasingly, physicians are being forced to choose between keeping their medical practices financially viable and treating all of the Medicare patients that need their services," the report said.

Other state medical associations are reporting similar trends, though most of the accounts were anecdotal. "I don't think people are blurting it out on the street, but it's evident that physicians across the country are quietly telling their patients that they can't see them anymore because Medicare doesn't pay them enough," Jean Irwin, chief executive officer and administrator of Family Health Care Associates in Dallas/Fort Worth, told this newspaper.

Of the 57 primary care physicians who work for Family Health Care, 5 have recently opted out of Medicare.

The Wisconsin Medical Society predicted a Medicare pinch as early as February. The state has a higher percentage of Medicare beneficiaries and a lower ratio of participating physicians than the national average, and Wisconsin is among the nation's lowest in terms of reimbursement. "This [5.4%] rate cut will only worsen the problem of doctors being forced out of the program," said John Patchett, chief executive officer and executive vice president of the society, Madison.

Physicians who attended the Oklahoma State Medical Association House of Delegates meeting in April spoke of possibly limiting their practices because of the Medicare pay cut. Joy Leuthard, director of health care policy and research for the association, located in Oklahoma City, said physicians in her state are already losing money because of low reimbursement and the hassles associated with claims reimbursement from Medicare and other insurance companies.

"We have an extremely low Medicaid reimbursement rate in Oklahoma," she said. The 5.4% Medicare reimbursement cut was the icing on the cake."

In Massachusetts, dropping patients wouldn't work to a physician's advantage because that state is the only one that essentially mandates physicians to accept Medicare assignment. "If you bill the patient more than the maximum allowable charge under Medicare, you lose your license," said Dr. Francis Rockett of Newton, president of the Massachusetts Medical Society. On the other hand, physicians who don't participate in the program get a significantly lower reimbursement, giving physicians little reason to opt out of the program.

In addition, the Massachusetts legislature recently threw out a provision that allowed dual eligibility for Medicare and Medicaid to the elderly poor.

State medical associations are actively lobbying against the Medicare physician payment formula.

A bill (HR 3351) introduced last year to revise the formula was referred to the House Ways and Means Committee in November 2001. No action has been taken since then.