Problems finding new Medicare primary care doctors small but growing

MedPAC's chair calls the trend "worrisome" and says it's another argument for repealing the SGR formula, which is keeping some physicians from accepting new patients.

By Charles Fiegl amednews staff — Posted Jan. 9, 2012

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A federal survey of Medicare beneficiaries shows that slightly more patients are having difficulty finding new primary care physicians to care for them.

Searching for a new family physician or internist who is accepting Medicare patients was more difficult than scheduling an appointment with a new specialist, according to an annual survey on physician access conducted by the Medicare Payment Advisory Commission. The 2011 survey found that 3.6% of Medicare patients reported having no problem finding a new primary care physician, while 2% had what they considered small or big problems finding one. All other patients surveyed were not looking for a new physician last year.

In previous years, surveys showed patients having relatively fewer problems scheduling appointments with new primary care physicians, said Cristina Boccuti, a MedPAC principal policy analyst, during a Dec. 15 commission meeting. Non-Medicare patients also reported more trouble last year.

"In general, for both Medicare and the privately insured groups, access to primary care physicians is trending down, which has been concerning the commission for a number of years," Boccuti said.

MedPAC Chair Glenn Hackbarth called the trend "worrisome" and said the new data reinforced the need to eliminate the sustainable growth rate formula that helps determine Medicare pay rates. The SGR was scheduled to reduce Medicare payments by 27.4% on Jan. 1, but Congress in December 2011 delayed the cut by two months, establishing a new deadline of March 1. The uncertainty caused by the SGR has dissuaded some physicians from accepting new Medicare patients or has prompted them to limit new appointment slots.

Federal lawmakers have continued to defer on a decision to eliminate the SGR by enacting temporary patches for the last decade, Hackbarth said. As a result, the cost of a repeal that would simply maintain current Medicare rates over 10 years has grown to $289.7 billion, according to the Congressional Budget Office. Repealing the formula and providing annual payment updates pegged to the increased costs over time of providing care would cost $352.7 billion, the CBO said.

The fiscal and political climate in Washington is not conducive to writing off these costs, Hackbarth said. The committee also has had concerns that any savings found in Medicare would continue to be used for purposes other than payment reform. For instance, the 2010 health system reform law was financed in part by more than $400 billion in Medicare cuts.

"So our fear as we discuss the SGR over the course of this calendar year is that we were getting closer and closer to the point where continuing the SGR could become a destabilizing force in the Medicare program, and hence the urgency of moving ahead with repeal," he said.

Commissioners discussed renewing their October 2011 recommendations to Congress for repealing the SGR. One recommendation suggests that Congress replace the SGR formula with a 10-year pay freeze for primary care, while reducing payments for other services by 5.9% for three years and then holding rates steady for years four through 10.

The American Medical Association has opposed that recommendation because it says the drastic cuts and freezes to physician pay would not preserve patients' access to care. Many physicians already are facing pay cuts related to Medicare requirements on electronic prescribing, electronic medical records and quality reporting. Reducing base pay or freezing rates would leave doctors unable to care for Medicare beneficiaries and unable to transition to new payment models that better coordinate patient care, the AMA has said.

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Some hard times finding a new physician

The Medicare Payment Advisory Commission's 2011 physician access survey compared beneficiaries and privately insured individuals 50 to 64 years old. The survey found that most patients can find a new doctor when they need one, but slightly more people reported difficulties accessing a new source of care than in 2010. The 2011 survey found that:

  • 6% of Medicare patients looked for a new primary care doctor.
  • 3.6% had no problem finding a new primary care physician, while 0.7% had a small problem and 1.3% had a big problem.
  • 14% sought care from a new specialist.
  • 12.1% had no problem finding a new specialist, while 1.1% had a small problem and 1% had a big problem.

Source: "Assessing payment adequacy: fee-schedule and ambulatory surgical center services," MedPAC, Dec. 15, 2011 (link)

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