WASHINGTON – Doctors say the looming cuts to Medicare reimbursement rates will be felt by patients in the form of less access to health care, and they say they have studies to prove it.
But other health care officials in Maryland said they have yet to see major problems in access for Medicare patients after the 5.4 percent cut at the start of this year.
Michelle Holzer, project officer for the Maryland Senior Health Insurance Assistance Program, has not kept close track of her calls but said there have not been “tons of phone calls from people going without doctors” in the state. The few calls she has received have come from people having problems finding a doctor to accept them as new Medicare patients, she said.
“For the state of Maryland, over the last four to five years, the leading issues have been the rise and fall of HMOs and prescription drugs,” said Holzer. “Most of the calls surround those issues rather than problems with access to physicians. It’s just not as great an issue like these others that have taken the forefront with seniors.”
But physicians say it will become an issue if something is not done.
An American Medical Association study earlier this year said 24 percent of physicians nationwide have either limited the number of Medicare patients that they treat or plan to put limits in the next few months. The study also found 80 percent of doctors who are 50 years or older may consider leaving or cutting back their practices if the Medicare cuts go into effect.
A survey by the American Academy of Family Physicians reported 17 percent of family doctors have decided not to take new Medicare patients since the cuts that went into effect in January.
But a spokeswoman for the Center for Studying Health System Change, an independent advocacy group, said the studies by medical associations should be taken with a grain of salt. Alwyn Cassil said no one has data right now to conclusively show a link between physician payment cuts and access to care.
A Medicare Rights Center survey of 30 state health insurance programs and Medicare-advocacy organizations also failed to turn up significant problems with access, said Deanne Beebe, communications director for the center. Maryland was included in the survey, but did not report any problems.
Eight of the 30 states surveyed — Tennessee, Missouri, Arizona, Virginia, New Hampshire, Texas, Rhode Island and New Mexico — have received more calls since January from people who cannot find a doctor. But half of the states said their Medicare patients were already struggling to find doctors, even before the January 2002 cuts.
Similarly, the Center for Studying Health System Change also found the number of doctors willing to take Medicare patients was already falling before the Jan. 1, 2002 cut, from 71 percent in 1997 to 68 percent in 2001.
Advocates also point out that Maryland is in a relatively better position to start: The state had 20 doctors per 1,000 Medicare beneficiaries in 1999, compared to a national average of 15.7 doctors per 1,000.
Of these physicians, more than 55 percent of family physicians are 50 or older and 31 percent are 60 or older.
But physicians say the danger is real and that the situation will just get worse unless Congress rewrites the current reimbursement formula.
“As physicians recognize that they can’t afford to provide care because reimbursements don’t cover the cost of care, they won’t sign up to provide those services,” said Dr. Catherine Smoot-Haselnus, president of the state medical society.
“Physicians will not sign Medicare patients and then it becomes an access issue — access to care, access to services,” she said.