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GAO Finds Few Medicare Beneficiaries Have Trouble Getting Doctor Care

By Mary Agnes Carey, CQ HealthBeat Associate Editor

July 21, 2006 -- As physicians warn Capitol Hill that seniors may have a tough time finding care if Medicare doctor payments are reduced, a Government Accountability Office (GAO) report released Friday concludes that no more than 7 percent of Medicare beneficiaries nationwide have had major difficulties accessing a physician.

In general, the GAO found that an increasing proportion of beneficiaries from April 2000 to April 2005 received physician services and an increasing number of physician services were provided to beneficiaries who were treated.

Two other access-related indicators—the number of physicians billing Medicare for services and the proportion of services for which Medicare's fees were accepted as payment in full—increased from April 2000 to April 2005. "These increases suggest that there was no reduction in the predominant tendency of physicians to accept Medicare patients and payments," GAO concluded.

Since the early 1990s, lawmakers, health care analysts, and physician groups have raised concerns that Medicare's attempts to control spending on physician services by limiting pay increases could hurt beneficiaries' access to physicians. Those concerns, GAO noted, were heightened in 2002 when Medicare's formula for setting physician fees required a 5.4 percent reduction in fees to help moderate rapid spending increases for physician services.

In January 2005, GAO reported that based on beneficiaries' utilization of physician services, the 2002 fee cut did not appear to have an immediate impact on beneficiary access to physician services and that access increased from April 2000 to April 2002. The report published Friday, which was mandated as part of the Medicare drug law (PL 108-173), looked at several areas, including trends and patterns in beneficiaries' perceptions of the availability of physician services from 2000–04, beneficiaries' use of physician services from 2000–05, and indicators of physician supply and willingness to serve Medicare beneficiaries from 2000–05.

But the American Medical Association cautioned that the GAO analysis "should not be interpreted as an improvement in access." The AMA's response, included in the GAO report, said increases in the utilization of physician services could be the result of beneficiaries growing sicker, the substitution of physician services in doctors' offices for care in the hospital or other settings, or beneficiaries taking advantage of new Medicare-covered benefits.

Separately on Monday, 80 senators sent a letter to Senate Republican and Democratic leaders urging them to increase Medicare physician payments before Congress adjourns in October. If Congress does not act, the Medicare sustainable growth rate will cut payments to physicians and health care professionals by about 5 percent as of Jan. 1, the senators warned.

The senators' letter also noted that a 2006 American Medical Association survey found that if there are payment cuts in 2007, 45 percent of physicians said they planned to decrease the number of new Medicare patients they accept and 43 percent will decrease the number of new Tricare patients they accept because Tricare ties its physician payment rates to Medicare's rates. Tricare is the health insurance program for military personnel and their families.

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