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MedPAC Considers 1 Percent Payment Increase for Doctors

By Jane Norman, CQ HealthBeat Associate Editor

December 2, 2010 -- Even as members of the Medicare Payment Advisory Commission (MedPAC) debated recommending a 1 percent increase in doctor payments for 2012, they stressed their frustration at Congress' series of five short-term adjustments to scheduled reimbursement cuts.

Several commissioners also questioned a survey by MedPAC staff that said that nationally, just a small percentage of beneficiaries find it difficult to see a doctor.

Their comments reflected growing unhappiness in the physician community about the scheduled large reductions in Medicare payment rates that Congress again postponed earlier this week. "This is the most disruptive thing that I see in the medical community, and I think most of us feel that way," said Ronald D. Castellanos, a physician with Southwest Florida Urologic Associates in Fort Myers, Fla.

Commission Chairman Glenn Hackbarth said that language in the commission's annual report to Congress should express the panel's dismay "as clearly and prominently as possible." Hackbarth said the repeated extensions and the disruptions they produce are "a real problem and a growing problem for the program."

The recommendation for a 1 percent payment increase could change before the commission votes on final recommendations to Congress in January, though members said they were comfortable with that level.

Congress is not obligated to follow the recommendations of MedPAC, an independent advisory body. But at a minimum they serve as a reference point for debate.

President Obama on Nov. 30 signed a law (PL 111-286) that would postpone for one month a scheduled 23 percent cut in physician payment rates that was scheduled to take effect Dec. 1. It will cost $1 billion over 10 years but would be offset by savings from within the physician payment system.

Senate Finance Chairman Max Baucus, D-Mont., and Sen. Charles E. Grassley of Iowa, the top Republican on the panel, have said they are working on an agreement to pay for a one-year postponement of the cuts. Republicans have objected to bills that fail to find other savings to cover the costs of the payments, although under budgetary pay-as-you-go rules Medicare reimbursements do not have to be offset.

A survey conducted by MedPAC staff this fall of 8,000 people and discussed at the meeting indicated that Medicare beneficiaries are not having much trouble finding doctors, which is similar to survey findings in the past.

The survey said that Medicare enrollees are less likely than privately insured people ages 50 to 64 to report unwanted delays in getting appointments with doctors. It also said that 75 percent of the Medicare beneficiaries contacted said they "never" had delays in getting routine care appointments, and 83 percent said they never had delays in getting an illness or injury appointment.

Medicare beneficiaries also were less likely than people with private insurance to report problems finding a new physician, according to the survey. Seven percent of those surveyed were looking for a new primary care provider. Among that 7 percent, 79 percent reported no problem and 12 percent reported a "big problem" finding a new doctor. MedPAC staff members said those with problems amount to about 1 percent of all beneficiaries, though it's still a concern.

However, the survey also noted that minorities experience more problems with access to care than whites. Among those seeking a routine care appointment, 76 percent of white beneficiaries said they never had a problem, while the figure was 74 percent for minorities. Among those seeking a new specialist, 5 percent of white Medicare beneficiaries found a big problem while 9 percent of those in minority groups said the same.

In response to questions from the panel, staff members said the survey did not capture physicians who say they accept new Medicare patients but have a shrinking number of appointment slots available for them.

Hackbarth noted there is a "disconnect" between the survey results and what members of Congress are hearing from constituents complaining about fewer doctors available who accept Medicare patients. He said he wasn't sure of the answer but speculated that the situation may vary from market to market. In Oregon, where he lives, Hackbarth said there are many retirees moving in and the physician supply has not kept pace.

He also pointed out that with 48 million Medicare beneficiaries, even a small percentage of people with problems finding care can generate a number of complaints.

The staff report also found that the volume of physician services per beneficiary continues to grow, based on an analysis of claims, and that most quality indicators in care were stable or improved between 2007 and 2009. In addition, Medicare payments continued to be about 80 percent of private payer rates, the same as in the previous year, and 99 percent of all charges were paid in full.

Commission members also received a draft recommendation to possibly increase reimbursements for ambulatory surgical centers by 0.6 percent, though there was also discussion of not voting on that a recommendation because little new information is available on the centers.

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