Reforming Medicare payment system creates divide among doctors

In a survey, 42% of respondents support cost-shifting of reimbursements, while 46% oppose it.

By Chris Silva — Posted Nov. 9, 2010

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While the majority of physicians agree that Medicare payments are inequitable and unfair, there is little consensus about how to reform the system, according to a study published in the Oct. 25 Archives of Internal Medicine.

Researchers examined survey responses from 1,222 physicians. Nearly 80% of respondents indicated that Medicare payments are unsatisfactory. Among doctors who accepted Medicare, 40% "strongly agreed" and 38% "somewhat agreed" that under Medicare some procedures are compensated too highly and others are compensated at rates insufficient to cover costs.

Of the three payment reform proposals researchers asked about, physicians showed the highest support for the use of incentives to improve quality (link).

Regarding cost-shifting of payments, 42% supported it, while 46% opposed it. Most doctors supported a shift in payments toward counseling and management compared with only 17% of surgeons. Support for shifting payments was less likely to be expressed by physicians in office-based settings, practice owners and those with fewer patient care hours.

Most physicians (69%) viewed bundling of payments unfavorably. There was low support among surgeons and other specialists for a 3% reduction in payments to offset increased payments to primary care.

"Overall, physicians seem to be opposed to reforms that risk lowering their incomes," said the study, which was conducted by researchers at the Mount Sinai School of Medicine in New York City and the James J. Peters Veterans Administration Medical Center in the Bronx, N.Y. "Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending and improve health care quality will be difficult."

The researchers added that further studies of trade-offs that physicians would be willing to accept in payment reform may help design new methods or models.

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