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Physician responses to Medicare physician payment reform: preliminary results on access to care
1Center for Health Policy Research, American Medical Association, Chicago, IL 60610.
Abstract:
This paper examines the impact of Medicare physician payment reform on access to care by comparing several physician-based access measures in the pre- and post-reform periods. The results suggest that the broad goals of payment reform may have been at least partially achieved: the proportion of physician revenues derived from Medicare increased for primary care physicians and decreased for nonprimary care MDs; there was little change in the absolute or relative number of visits provided to Medicare patients; and an increasing number of physicians charged no more than the Medicare payment amount. Some signs of deteriorating access were found, however. Fewer physicians were willing to treat all new Medicare patients and more physicians accepted no new Medicare patients. Furthermore, there was an increase in the proportion of physicians who reduced or stopped providing to Medicare patients certain types of services that they continued to provide to other patients.
Insights
Medicare physician payment reform partially achieved goals, increasing primary care revenue but showing some access deterioration. Fewer physicians accepted new Medicare patients, and some reduced services for Medicare patients.
Area of Science:
- Health economics
- Healthcare policy
- Medical practice management
Background:
- Medicare physician payment reform aimed to influence physician behavior and improve care access.
- Understanding the effects of such reforms is crucial for sustainable healthcare systems.
Purpose of the Study:
- To evaluate the impact of Medicare physician payment reform on patient access to physician care.
- To compare physician-based access metrics before and after the payment reform implementation.
Main Methods:
- Analysis of physician-based access measures.
- Comparison of pre- and post-reform periods to assess changes in physician behavior and service provision.
- Examination of Medicare patient visit data and physician acceptance rates.
Main Results:
- Increased proportion of physician revenues from Medicare for primary care physicians; decreased for non-primary care physicians.
- Minimal change in the absolute or relative number of visits provided to Medicare patients.
- Growing number of physicians accepting Medicare payment amounts, but reduced willingness to treat all new Medicare patients and some service reductions for Medicare patients compared to other patients.
Conclusions:
- Medicare physician payment reform showed mixed results, with partial achievement of broad goals but emerging signs of access deterioration.
- While some physicians adapted to payment changes, others limited new patient acceptance and service provision for Medicare beneficiaries.
- Policy adjustments may be needed to fully ensure consistent access to care for all Medicare patients.