Access to doctors drops
Payment cuts push physicians away from government-backed care
Medicare beneficiaries around the country are able to get appointments with doctors, but physicians groups and local doctors said continued reductions in government reimbursement could threaten the elderly’s access to health care.
People covered by Medicaid — TennCare in Tennessee — have trouble finding physicians who accept their coverage, according to national studies and local health care advocates.
Dr. Colleen Schmitt, a Chattanooga gastroenterologist, said paperwork and bureaucratic tangles prompted her practice to stop accepting TennCare patients several years ago.
If Medicare payments continue to decline, she said she may stop seeing Medicare patients, as well.
“I won’t be able to take care of them. It just won’t be possible,” she said. “It’s not that I don’t want to care for patients.”
Doctors are not legally required
to accept either Medicare, the federal insurance program for the aged and disabled, or Medicaid, the state-run program mostly for the poor and children.
While there is little evidence of a national Medicare access crisis, research shows that Medicaid enrollees’ choices are shrinking when it comes to finding a physician and getting appointments when they need them.
According to a March report from the Medicare Payment Advisory Committee, an independent federal advisory group, Medicare enrollees do not have significantly more trouble than their privately insured counterparts in getting an appointment with a primary care physician or a specialist.
Another report from the independent U.S. Government Accountability Office issued in July echoed those findings. It noted that only about 7 percent of Medicare enrollees encountered major difficulties in finding a doctor in the years 2000 to 2004.
By contrast, a report issued last month from the nonprofit, nonpartisan Center for Studying Health System Change found that Medicaid patients across the country increasingly are concentrated among a few doctors. Those doctors tend to work for hospital-owned practices or clinics rather than operating a private practice, the report stated.
In an American Medical Association survey of member physicians, 45 percent said they would reduce or stop accepting new Medicare patients in response to a 5 percent cut in Medicare reimbursements set to take effect in 2007. The survey was conducted as part of the group’s campaign against reimbursement cuts.
“Doctors continually have to fight to decide whether it makes business sense to treat Medicare patients or not,” said Russ Miller, senior vice president of communication and membership at the Tennessee Medical Association.
Bill Taylor, a Chattanooga health care consultant who manages physician practices, said all of his clients around the country are considering limiting or eliminating Medicare or Medicaid patients or both.
It isn’t difficult to see why, he said. Medicare reimburses on a per-unit basis. For example, a primary care exam for an established patient equals 1.3 units, equal to about $49. Medicare’s per-unit reimbursement for physicians now sits at $37.90. In January, it’s set to drop to $35.97.
Private insurers in Tennessee pay $40 to $47 for that same unit. Medicaid reimburses about $29 per unit.
Meanwhile, costs for the practices for which he consults range from $38 to $55 per unit, so physicians are faced with the choice of whether to continue caring for the poor, aged and disabled at a loss, Mr. Taylor said.
Declining numbers of medical students choosing careers in primary care also have contributed to the problem of ensuring there are adequate physicians for both privately and publicly insured patients, said Dr. B.W. Ruffner, interim dean of the University of Tennessee College of Medicine, Chattanooga Unit.
“Interest in family medicine, internal medicine and pediatrics is down, and demand is increasing,” Dr. Ruffner said.
Access to physicians is a problem in Georgia as well, health care advocates said.
“I don’t think there’s any question there is a problem both with regard to Medicaid and Medicare,” said David Cook, executive director of the Medical Association of Georgia. “We are seeing an increasing number of physicians who are unwilling to accept Medicare and Medicaid.”
Younger physicians are more business-minded than some of their older counterparts, and in some cases are choosing not to provide care for publicly insured patients where it means a financial loss, he said.