Medicare and Reduced Provider Reimbursement- Consequences for Healthy Aging As of January 1, 2002 Medicare has cut reimbursements to doctors who treat Medicare patients by 5.4 percent across the board - that means all physicians regardless of specialty and regardless of place of practice. The purpose in addressing this issue is not to get out the sympathy vote for physicians, but rather to use this congressional decision to wonder what is the long-term affect of this type of public policy on the health of aging Americans. There are a number of considerations.
1. Will physicians continue to accept Medicare patients? We live in a country where medical care is not a guaranteed right. This is why there are so many uninsured people whose medical care is therefore variable depending on the insurance or non-insurance that the patient cares. Patients including the uninsured get care, but the uninsured usually wait until their treatments require more expensive therapy than had they seen a physician regularly. Physicians and hospitals are reimbursed for caring for patients (and others in different circumstances) over 65 through the Federal Governmental Medicare program. Most Seabrookers are familiar with this program and many are entitled to its benefits. There are 39 million Americans qualified for Medicare, but physicians in increasing numbers are refusing to accept new medicare patients because of the new reimbursement policy. The exact number of physicians who have taken this stand is unknown, but it is substantial and will undoubtedly cause stress to patients whose government has decided to pay less this year and for the next several years even though all the costs to the physicians continue to rise each year.
2. What is the effect on patients whose physicians continue to see Medicare patients? Again we can only guess, but if one considers the economics - less money and more patients, then the inevitable result will have to be less time between doctor and patient. This most special of all aspects of medicine - the doctor patient relationship, has changed with managed care and now with Medicare, it is hard to envision how this will improve this aspect of a relationship that is important to both the patient and the doctor. Physicians are faced with increased and fixed costs each year and as they see more patients (because other physicians refuse to see them) the only way to avoid a financially disastrous situation is to shorten the time with each patient.
3. Will there be fewer physicians in the future? Medical school applications are down 26 percent over the past five years, although MUSC applications are up slightly. Nevertheless, just as in nursing, the kind of policy that reduces reimbursement for physicians results in less income and this could have a negative impact on attracting college graduates into the profession. This would be another unwholesome and unwelcome effect of the new Congressional policy.
4. What will be the effect around the country in physician distribution? It is already hard to recruit physicians to rural America. We have a number of programs in South Carolina designed to try and get more physicians into less populated areas where the populations tend to be older than in the urban areas. The new Medicare reimbursement rules will almost certainly make it more difficult than ever to recruit physicians to rural areas- the physicians simply cannot afford to go there. Will this lead to even more congestion of urban areas? Who knows, but it could.
5. What about quality of care? One would hope that quality of care per se will not be hampered by the new policy. Physicians will do all that they can to continue to practice the best quality of care despite the reimbursement. I think this effort will largely be successful.
So what is the prognosis? I have written before in this column about policy and the effect it has on healthy aging. It is likely that this latest development will cause some further change once it becomes clear that there are many unintended consequences. What might have seemed like a responsible way to try to halt the increases in the Medicare budget (driven mainly by the greatly increased number of eligible citizens and the expanded coverages) is having undesirable effects. Sooner rather than later the entire Medicare program and indeed all of US health care insurance is going to have to be reworked. Until then encourage your physician to continue to accept Medicare patients - not just you, but new patients as well. Having access to medical care is an essential element in successful healthy aging.
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