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Patients’ access to physicians under Medicare

A new study released by the Centers for Studying Health System Change indicates that almost three-quarters of the nation’s physicians are still accepting Medicare patients. A relatively small fraction (3.4%) stated their practices were completely closed to all new Medicare patients. Both results were from the 2004-2005 period, and reflect a relatively static level of physician acceptance of Medicare patients.
Medicare access is roughly comparable to access by individuals with private insurance despite the fact that Medicare reimbursement is about 20% lower than commercial payers. The good news for providers is that this rate is much better than it has been; historically Medicare paid only about 71% of private payers’ reimbursement for similar procedures.
Interestingly, the volume of services provided to medicare patients continues to increase, with the latest statistics showing an 18% increase in minor procedures from 2003-2005, after an average 6% annual increase in preceding years.
Perhaps physicians consider themselves fortunate to have Medicare and not Medicaid patients. The state-federal run Medicaid program is the worst payer, with rates over 30% less than Medicare.
The report did not delve into Medicare access results.
What does this mean for you?
Medicaid continues to get the short end of the stick, as do its patients and providers.
The data on the sharp increase in utilization in Medicare is potentially troubling; it may represent cost-shifting as providers seek to maximize compensation through additional billing.

Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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