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Medicare Patients Costs to Rise as Number of Non-Participating Providers Grows

September 17, 2002

Looming Deadline for Providers Ignored as Congress Heads into Elections

(Washington, DC): Unless Congress acts to halt fee schedule cuts by November 1, Medicare patients face diminished physician participation in the program, reduced access to care and rising out of pocket costs, according to Sara Walker, MD, MACP, president of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM).

On or around November 1, Medicare will finalize the 2003 fee schedule and inform physicians of the new rates. Physicians will then have to make an immediate decision on their participation status with Medicare for calendar year 2003.

"Many practices cannot afford to absorb another 4 percent decrease in 2003, on top of this years' 5.4 percent decrease," said Dr. Walker. "Some physicians will conclude that the only way they can continue to see their existing Medicare patients is by switching from participating to non-participating status. Other physicians may renew their participation agreements, but limit the number of Medicare patients they can see. Either way, patients pay the price for the government's failure to pay its fair share."

Recent surveys show that as many as one out of four physicians will no longer continue as participating providers if Medicare payments are cut again. According to an ACP-ASIM analysis of Medicare's payment formula, out-of-pocket expenses for "unassigned claims" by non-participating physicians are 66 percent higher than for "assigned" claims by participating physicians. Any substantial decline in the number of participating physicians could result in millions of additional out-of-pocket expenses to beneficiaries.

"Through a complicated formula, Medicare will actually pay less, while the total fee for services increases and the patient picks up the difference," said Dr Walker.

Seven different studies, each with different sponsors and different methodologies, were consistent in finding that Medicare patients' access is deteriorating and that further cuts are likely to worsen the situation. Not only the surveys by medical organizations, but independent studies from the Medicare Payment Advisory Commission, the Center for Studying Health System Change, and the Medicare Rights Center found evidence of significant declines in Medicare patient access.

"Patients are already reporting problems finding a physician, obtaining timely appointments and spending less time with their physicians," said Dr. Walker. "If Congress waits until the fee schedule has already been published, it will be too late for many physicians to change their minds."

The American College of Physicians-American Society of Internal Medicine is the nation's largest medical specialty organization and second largest physician group. Its membership includes more than 115,000 internal medicine physicians and medical students. Internists are specialists in the prevention, detection and treatment of illnesses that primarily affect adults. They provide care to more Medicare patients than other physician specialty.

Jennifer Whalen, (202) 261-4575, jennw@acponline.org
Jack Pope, (202) 261-4556, jackp@acponline.org

Page updated: 11-04-03

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