Finding Physicians May Be Problem if Medicare Fee Cuts Enacted

Many physicians responding to a recent survey reported that the payments they receive from public health care programs such as Medicare and Medicaid are insufficient and are impeding their ability to treat the growing number of people who are enrolled in them.

A further reduction in Medicare's physician reimbursement, slated to take place January 1, 2010, will be untenable, respondents maintained.

The likely impact of planned Medicare fee cuts was among the findings in a nationwide survey sponsored by the Physicians' Foundation, a nonprofit organization that gives grants “to advance the work of practicing physicians and to improve the quality of health care for all Americans.” Its members are medical societies and physicians. The survey, which was conducted in the first half of 2008, was sent to about 320,000 family physicians, general internists, pediatricians, and obstetrician/gynecologists in “active practice” listed in the AMA Physician Masterfile. About 11,950 physicians responded.

The results, released late last year, demonstrated that “declining reimbursement” was rated highest on a list of issues that physicians identify as impediments to the delivery of patient care in their practices.

Many of the reimbursement concerns that the physicians identified in the survey focused on public health care financing systems. For instance, 65 percent of respondents said Medicaid reimbursements for services are less than the cost of the care provided, and 36 percent said Medicare reimbursements also are less than the cost of providing care.

The findings did not surprise Laurence Miller, M.D., chair of APA's Committee on Public Funding for Psychiatric Services.

“More and more practices are not taking Medicare or Medicaid patients at all” due to the low reimbursements, Miller said.

The survey's findings seem to bear out this statement. More than 33 percent of physicians surveyed have closed their practices to new Medicaid patients, and 12 percent have closed their practices to new Medicare patients.

It's not just a physician's personal income that is affected. The impact of low reimbursements on physicians' practices has included an inability to provide staff raises, purchase new equipment, and devote the optimum amount of time to each patient.

Another possible result of the low reimbursements is limiting the ability of physicians to adopt modern time- and money-saving technology. Among the respondents who lack an electronic medical record system—a priority for health care reformers—77 percent said they cannot afford the cost of adopting such technology.