Access to Physicians’ Services for Medicare Beneficiaries

By: Adele Shartzer, Rachael Zuckerman, Audrey McDowell, and Richard Kronick
U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation, August 2013

Key Findings:

–  According to federal survey data, the percentage of all office-based physicians who report accepting new Medicare patients has not changed significantly between 2005 and 2012, with 87.9% of physicians accepting new Medicare patients in 2005 and 90.7% in 2012.

–  The percentage of physicians who report accepting new Medicare patients is similar to, and in recent years slightly higher than, the percentage accepting new privately insured patients.

–  Medicare beneficiary access to care is high and has remained stable over the past five years.

According to Centers for Medicare and Medicaid Services (CMS) data, there were about 650,000 physicians who participated in the Medicare program in 2011 and nearly 1 million participating providers in total (including non-physician providers such as nurse practitioners). It is clear from the data the percentage of all physicians who accept new Medicare patients has been stable from 2005 to 2012. To the extent that there may have been a very small increase in the number of providers ‘opting out’, that increase has been mitigated by an increase in the share of other physicians who accept new Medicare patients. Further, the total number of providers participating in and billing Medicare has steadily increased since 2007.

These findings allay concern that the number of physicians ‘opting out’ of Medicare has increased in recent years.[4] (Footnote 4: Beck, M. “More Doctors Steer Clear of Medicare”, Wall Street Journal 7/29/13 p.A1, vCCLXII #24. This article reported that the number of physicians opting out of Medicare increased from 3,700 in 2009 to 9,539 in 2012.)

A 2005 study examining characteristics of providers opting out of Medicare found that overall less than one percent of providers eligible to opt out of Medicare did so, and the two specialties with the highest opt out percentages were psychiatrists (with 1.11% opting out) and plastic and reconstructive surgeons (with 1.56% opting out). In contrast, about a third of one percent of primary care physicians (0.35%) opted out of Medicare.

In its March 2013 Report to Congress, based on this and other federal surveys, MedPAC noted that Medicare beneficiaries report good access to care, and access to physicians’ services has remained stable over the past five years. Similarly, the large majority of beneficiaries had no problems getting an appointment with a new physician, and again the results are comparable to those for people with private insurance. Additionally, Medicare beneficiaries were less likely than the privately insured to report forgoing needed medical care (8% vs. 11%) in 2012.

Conclusion

Approximately 90% of all office-based physicians report accepting new Medicare patients. The percentage of physicians who report accepting new Medicare patients is similar to the percentage of physicians who report accepting new privately insured patients. In addition, the share accepting new Medicare patients has been relatively stable over the 2005-2012 period and shows a slight increase in 2011-2012 based on initial NAMCS data.  Beneficiary reports of access to care, including the ability to find a physician and see a doctor in a timely manner, are also favorable. Again, these results are comparable to reports by patients with private insurance and have been stable over time. Overall, Medicare beneficiary access to care has been consistently high over the last decade and continues to be high today.

http://aspe.hhs.gov/health/reports/2013/PhysicianMedicare/ib_PhysicianMe…

This highly credible report lays to rest the nonsense perpetrated by media reports such as the recent Wall Street Journal article, “More Doctors Steer Clear of Medicare.” Although some physicians have stopped accepting new Medicare patients because of overload, over 90 percent still do, more than those who accept new privately insured patients. A few isolated anecdotes do not alter the truth.

Opponents of an improved Medicare for all have suggested that physicians would bale out in droves if that were the only insurance program in the U.S. But where would they go?

Everyone automatically would be enrolled in the Medicare program. Why would patients want to buy a private plan duplicating Medicare benefits when they are already paying obligatory taxes for the Medicare program? There would be no market for such plans, not to mention that consumers would be protected by making them illegal.

It would not be long before the physicians who opted out for a cash-only practice would discover that there would not be enough cash to support them. In fact, today 20 percent of concierge practices fail and that number has been increasing.

Under a Medicare for all program there simply would not be enough patients who would want to pay more than they would already be paying in taxes to support more than a minute contingency of cash-only concierge practices. Virtually all physicians would accept Medicare, without giving it a second thought, though the Wall Street Journal might then have to turn to the contrived scandal of the physician glut in Medicare.