Are Physicians Closing Their Doors to Medicare? Trends and Patterns in the Provision of Physician Services to Medicare Patients.
Keywords: Access, Medicare, Physician Services
Context: Over the past decade, Medicare cost control attempts have resulted in threats to physician payment rates, including a 5.4% cut (2002). Annual threats of cuts have raised concerns that some physicians might start closing their doors to beneficiaries. Attempts to determine whether physicians have actually started closing their doors have yielded inconsistent results.
Objective: Obtain credible evidence on whether physicians are closing their doors to Medicare beneficiaries (1996-2006) using: (1) longitudinal and cross-sectional claims data; (2) novel measures of access; (3) map and compare results across geographies. Design: Analyzed full year Medicare outpatient claims data from four State-wide representative cross-sectional and four longitudinal physician samples (1996, 2000, 2003, and 2006). Outcome Measure: Access as percentage of physicians providing services to at least one “new” beneficiary and average number of “new” patient visits per 1,000 beneficiaries per year. Used SUDAAN(v10) for most analyses.
Results: 1) 26-32% physicians had no UPINs and were not providing Medicare services. These physicians had characteristics similar to other physicians. 2) Regardless of specialty, age-group or sample, each year, physicians cut their “new” beneficiary visits. In 1996-2000 by 4.2%, 7.7% (in 2000-2003), and 2.2% (in 2003-2006). Average annual number of new visits per 1000 beneficiaries dropped to below 50 for physicians of all ages. 3) Physicians in rural areas were more likely to limit new patient visits compared to urban physicians. In almost all States there was a decrease in access to physicians (2000-2006).
Conclusions: Used new visits, as indicator of Medicare access, because past surveys indicated that when pressured, physicians may limit acceptance of new patients. A reduction in new visits may signal reduction in access, or saturation of panels and no admission of new patients. The result is the same even though they may have different policy solutions