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Medicare Patients’ Access to Physicians: A Synthesis of the Evidence

Issue Brief
  1.     Cable News Network, “State of the Union with Candy Crowley,” Mike Rogers, Ezekiel Emanuel, and John Fleming Interview transcript. October 27, 2013 at [http://transcripts.cnn.com/TRANSCRIPTS/1310/27/sotu.01.html].  Melinda Becker, “More Doctors Steer Clear of Medicare, Some Doctors Opt Out of Program Frustrated With Payment Rates and Mounting Rules,” New York Times, July 29, 2013; Paula Span, “Found: Doctors Who Take Medicare,” New York Times, July 6, 2011; Julie Connelly, “Doctors are Opting Out of Medicare,” New York Times, April 1, 2009.

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  2.     Clune, Sarah, “Finding a Doctor Who Accepts Medicare,” PBS News Hour, March 4, 2013. Carrie Teegardin, “Medicare: Is there a doctor in the house?,” Atlanta Journal-Constitution, December 13, 2010.

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  3.    All analyses using the MCBS in this issue brief exclude beneficiaries who reside in nursing facilities or other institutional settings.

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  4.    Medical Expenditure Panel Survey, 2010.  “Usual Source of Health Care and Selected Population Characteristics, United States.” Customizable Table downloaded from AHRQ website http://meps.ahrq.gov/data_stats/quick_tables_results.jsp?component=1&subcomponent=0&year=-1&tableSeries=6&searchText=&SearchMethod=1&Action=Search;  Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. National Center for Health Statistics. Vital Health Stat 10, No 256 (December 2012).

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  5.     Another 17% of Medicare seniors and 21% of privately insured individuals stated that they “sometimes” had to wait longer than they wanted to get routine care appointments. Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy, Chapter 4, March 2013.

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  6.   Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy, Chapter 4, March 2013.

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  7.   Cubanski, Juliette, and Patricia Neuman.  “Medicare Doesn’t Work As Well For Younger, Disabled Beneficiaries As It Does For Older Enrollees,” Health Affairs 29, No. 9 (September 2010).

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  8.   Nonwhite Medicare seniors were statistically more likely to report “big problems” finding a specialist, and nonwhite privately insured 50-64 year olds were more likely to report experiencing “small problems” and less likely to report experiencing “no problems.” Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy, Chapter 4, March 2013.

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  9.    Yee, Tracy, Peter Cunningham, Gretchen Jacobson, Patricia Neuman, and Zachary Levinson. “Cost and Access Challenges: A Comparison of Experiences Between Uninsured and Privately Insured Adults Aged 55 to 64 with Seniors on Medicare,” Kaiser Family Foundation (May 2012); Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy, Chapter 4, March 2013.

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  10.     Results from another survey, the NHIS, shows that 3.7% of Medicare beneficiaries and 2.5% of privately insured said they were told by the doctor’s office or clinic that they would not accept their insurance.  It is difficult to discern for Medicare beneficiaries, whether the insurance being referenced is Medicare, Medicare Advantage, and/or other supplemental coverage, including Medicaid.

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  11.    Davis, Karen, Kristof Stremikis, Michelle M. Doty, and Mark A. Zezza.  “Medicare Beneficiaries Are Less Likely to Experience Cost-And Access-Related Problems Than Adults With Private Coverage,” Health Affairs 31, No. 8 (August 2012).

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  12.   The NAMCS excludes facility-based specialties such as emergency-room physicians, radiologists and pathologists. Additionally, this analysis excludes pediatricians and pediatric subspecialists from acceptance rates for new Medicare patients and new private non-capitated patients to facilitate comparison between the two insurance categories.

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  13.   Capitated insurance typically pays providers, such as primary care physicians, a monthly amount per covered patient in the provider’s caseload, rather than per-service reimbursements typical of non-capitated insurance.

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  14.   Bishop, Tara F., Alex D. Federman, Salomeh Keyhani.  “Declines in Physician Acceptance of Medicare and Private Coverage,” Archives of Internal Medicine 171, No. 12 (June 2011); Boukus, Ellyn, Alwyn Cassil, Ann S. O’Malley. “A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey,” Center for Studying Health System Change, Data Bulletin, No. 35 (September 2009). Decker, Sandra. “In 2011 Nearly One-Third Of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help,” Health Affairs, 31, no.8 (2012).

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  15.   The Physicians Foundation, A Survey of America’s Physicians: Practice Patterns and Perspectives,  September, 2012. This survey asked a separate question that included actions that physicians are planning to take in the future "as a results of ongoing problems with the Medicare fee schedule." Rates of limiting acceptance of Medicare and Medicaid patients were higher than those reported in the question asking only about actions actually taken. Other activities in the question about planned actions included renegotiating or terminating some commercial health plan contracts, and to a lesser extent opting out of Medicare, and change to nonparticipating status.

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  16.   Hoadley, Jack, Laura Summer, and Ayesha Mahmud. “Findings from Beneficiary and Physician Focus Groups,” NORC and Georgetown University, Prepared for the Medicare Payment Advisory Commission (October 2009).

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  17.           For this calculation, data on the number of Medicare beneficiaries in each state come from Kaiser Family Foundation analysis of the State/County Penetration file, released by CMS in March of 2011.

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  18.           Ginsberg, Paul. “Wide Variation in Hospital and Physician Payment Rates Evidence of Provider Market Power,” Center for Studying Health System Change, Research Brief, No. 16 (November 2010).

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  19.   Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy, Chapter 4, March 2013.

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  20.   Goodman David C., and Kevin Grumbach. “Does Having More Physicians Lead to Better Health System Performance?” JAMA, vol. 299, no. 3 (2008).

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  21.   This “participation rate” (96%) applies to physicians and other health professionals, such as nurse practitioners, physicians assistants, physical therapists. Centers for Medicare and Medicaid Services, Data Compendium 2011. “Medicare Part B Participating Physicians and Other Practitioners by State Selected Years. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/DataCompendium/2011_Data_Compendium.html

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  22. Data on opt-out physicians (with either a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) degree) and non-physician doctors (chiropractors, oral surgeon dentists, podiatrists, and optometrists) are derived from unpublished data from the Center for Medicare and Medicaid Services and reflect physician/doctor opt-out status as of September 30, 2013.

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  23.           Health Resources and Services Administration, “The U.S. Nursing Workforce: Trends in Supply and Education,” (2013).  Auerbach, David. “Will the NP workforce grow in the future? New forecasts and implications for healthcare delivery,” Medical Care 50 No 7 (July 2012).   Roderick S. Hooker, James F. Cawley, and Christine M. Everett. "Predictive modeling the physician assistant supply: 2010-2025," Public Health Reports 126 (September/October 2011).

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  24.           Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy, Chapter 4, March 2013.

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  25. Grover, Atul and Lidia M. Niecko-Najjum, “Building A Health Care Workforce For The Future: More Physicians, Professional Reforms, and Technological Advances,” Health Affairs 32, No. 11 (November 2013). Dall, Timothy M., Paul D. Gallo, Ritasree Chakrabarti, Terry West, April P. Semilla and Michael V. Storm, “An Aging Population and Growing Disease Burden Will Require a Large and Specialized Health Care Workforce By 2025” Health Affairs 32, No. 11 (November 2013). Bodenheimer, T., M. Smith “Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians.” Health Affairs 32, No. 11 (November 2013).

     

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