May 2011

…and three other questions about physician care.

Do Medicare patients have shorter waiting times than those with commercial insurance?

• In the 2010 survey, among those seeking an appointment, most beneficiaries (75 percent) and most privately insured individuals (72 percent) reported “never” having to wait longer than they wanted for an appointment for routine care.
• Another 17 percent of Medicare beneficiaries and 21 percent of privately insured individuals reported that they “sometimes” had to wait longer than they wanted for a routine appointment.Finding a primary care physician was more difficult for privately insured individuals than for Medicare beneficiaries.  Seventy nine percent of Medicare beneficiaries reported that they had no problem finding a PCP compared to 69 percent of privately insured individuals.

Is Medicare the new Medicaid?

The answer is not yet; providers are still accepting Medicare patients at high rates, but the trend is towards fewer PCPs accepting Medicare.

• “For 2008, among physicians with at least 10 percent of their practice revenue coming from Medicare, 90 percent accepted new Medicare patients. By specialty, 83 percent of primary care physicians and about 95 percent of physicians in all other specialties accepted new Medicare patients. The rate of primary care physicians accepting new Medicare patients fell from 88 percent in 2007.”
• Medicare’s payment for physician fee-schedule services in 2009 averaged 80 percent of commercial rates for preferred provider organizations (PPOs)

Is concierge medicine the wave of the future?

Not yet.  In the fall of 2009, researchers found that there were 750 retainer-based or “concierge” physicians.  Thus number represents less than 1 percent of the total number of physicians practicing in the United States.  However, there is a trend towards more concierge medicine.  There was a 50% annual increase in the number of retainer-based practices from 2005 to 2009.

Where types of physician care is growing the fastest (and slowest)?

• Volume per beneficiary grew 3.3 percent in 2009.
• However, there was a decrease in 2009 of coronary artery bypass grafts (CABG), cardiovascular stress tests, colonoscopy, standard chest imaging, hip fracture repair, brain MRIs, and coronary angioplasty.
• Increases in service volume per beneficiary were found in advanced, non-standard computed tomography (CT) scans, outpatient rehabiliation, and spine surgery.

What recent legislation will affect the provision of physician services in the coming years?

• Since 1991, physicians and other health professionals who practice in designated health professional shortage areas (HPSAs) automatically receive a 10 percent bonus (relative to the fee schedule amount) on all Medicare services they provide.
• Starting in 2010, CMS no longer recognizes the billing codes for consultation services
• Starting in 2010, CMS started a four-year transition to practice expense relative values that incorporate data from the Physician Practice Information Survey.
• Starting in 2011 and ending in 2016, primary care practitioners will receive a 10 percent increase in payments for selected Medicare services, as will general surgeons practicing in HPSAs
• Under the Physician Quality Reporting System (PQRS), physicians and other health professionals may qualify for a 1 percent bonus on all Medicare services they provide in 2011 and a 0.5 percent bonus in 2012 through 2014.
• Starting in 2015, those who do not satisfactorily report PQRS measures will be subject to a financial penalty starting at 1.5 percent of their Medicare services.
• EHR incentive programs provides physicians with incentive payments for meaningful use of electronic health records (EHR).
• Starting in 2015, eligible physicians who do not satisfy the EHR criteria will be subject to a financial penalty starting at 1 percent of their Medicare services.
• Reimbursement changes from Health Reform (PPACA) can be found here.

Source:

• MedPAC March 2010 Report to Congress.