Part B Insider (Multispecialty) Coding Alert

More and more physicians are hesitating to take on new Medicare patients - but they still prefer Medicare beneficiaries to Medicaid and HMO patients.

The latest survey of physicians by the Medicare Payment Advisory Commission comes up with an ambivalent picture of physicians' attitudes to Medicare. On one hand, physicians are definitely being more picky about taking on new Medicare patients. On the other hand, they're not utterly disgusted by the program's recent vicissitudes.

MedPAC sponsored the national survey during 2002 to monitor the impact of the January 2002 fee schedule changes on beneficiaries' access to care. The Project HOPE Center for Health Affairs in Bethesda, Md., heard from 782 physicians, roughly 52 percent of those who received surveys.

The survey found that:
 

Physicians' satisfaction with the practice of medicine has held steady since 1999, despite cuts and other concerns.
 

External review of physicians' decisions didn't concern physicians nearly as much as reimbursement, billing, paperwork, malpractice issues and timely payment.
 

Physicians were less worried about billing and reimbursement issues in general for their fee-for-service Medicare patients than for managed-care and Medicaid patients. But they viewed Medicare less favorably than other payers when it came to concern about reimbursement and external review of their clinical decisions. Physicians who were aware of recent payment cuts were more likely to be concerned about Medicare's reimbursement levels in general.

A quarter of physicians are concerned about fraud-and-abuse investigations, and more than two-thirds of all respondents say they've billed more conservatively than they felt was merited because of those fears. A small number have restricted their acceptance of new Medicare patients due to fears of fraud investigations.

The proportion of physicians who accept all new Medicare patients has dropped by 6.3 percent since 1999, in line with the drop for HMO patients and less than the drop in access for Medicaid patients. More than 30 percent of physicians now refuse to accept any new Medicaid patients. The more concerned a physician was about Medicare, the less likely the physician was to accept new fee-for-service Medicare patients.
 

Physicians said it was harder to refer their FFS Medicare patients than their private FFS and PPO patients, but easier than for Medicaid or HMO patients.
 

One in 10 physicians said FFS Medicare patients had less priority in getting appointments than a year earlier. Physicians were aware of recent cuts and were tightening access somewhat as a result, MedPAC reports.

Some practices had hired extra billing and administrative staff in the past year to deal with added paperwork.