Report: Medicare reimbursement rates do not impact access

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Concerns have arisen recently over efforts by Medicare to try to control spending on physician services. In 2002 these concerns were raised up a notch when a change was made to the payment formula which called for a 5.4 percent drop in fees to counter spending increases.

According to the U.S. Government Accountability Office (GAO), which is required by law to review beneficiary access to physicians, between 2000 and 2004 the level of access (i.e. finding a personal provider or specialist, or not being able to get an appointment) remained relatively constant. Nationally, the number of beneficiaries that reported access troubles never rose above 7 percent.
   
Actually contrary to fears, GAO found that from April 2000 to April 2005, more beneficiaries received physician services and an increasing number of physician services were provided. 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. Generally, these trends suggest that there was no reduction in the predominant tendency of physicians to accept Medicare patients and payments, the GAO found.

For the report, GAO analyzed several years of data from an annual survey of FFS Medicare beneficiaries as well as utilization trends based on all Medicare physician during the period.

Regardless of these findings, lawmakers are debating the merits of the reimbursement cuts and could be preparing to rescind them over fears that reductions in payments could further drive up Medicare premiums and provoke physicians to leave the program, the AP reports.

Medicare doctor fees are reported to have gone up 4.5 percent from 2000 to 2005, and spending per patient for doctor services went up 45 percent as people made more visits and received more costly services, the AP reports.

In recent years Congress has not permitted the cuts to go through, and the last doctor fee cut (4.8 percent) occurred in 2002. Since then, Congress has rejected the mandated reductions and allowed small increases in payments, which again will probably happen this year, the AP reports.

There has been much debate about the system through which the cuts are calculated, and over replacements payments systems. One is to connect fees to the Medicare economic index, whereas it is now linked to increases in the GDP; others suggest the development of a pay-for-performance program, with increases linked to quality and results of care, the AP reports.