A number of articles in the lay and medical press report a decline in the number of physicians who accept patients with Medicare ... The percentage of physicians accepting new patients did not vary significantly between 2005 and 2008, ranging from 94.2% to 95.3%. Physician acceptance of new Medicare patients dropped [2.6%]. Physicians in private practice were largely responsible for the declining acceptance of Medicare patients as determined in stratified analyses ... There was a more pronounced decline in physician acceptance of patients with private noncapitated insurance [which dropped 5.5%]. A smaller percentage of adult primary care physicians accepted private noncapitated patients over the study period [dropping 7.4%].
Rates of acceptance of new Medicaid and private capitated patients were lower than Medicare and private noncapitated insurance, but also showed a decline over the study period. Acceptance of self-paying patients was more than 96% in all years and did not change significantly over the study period.
While reports in the press highlight physicians’ dissatisfaction with Medicare, we found only a small decline in physician acceptance of Medicare patients between 2005 and 2008. In contrast, the decline in physician acceptance of noncapitated privately insured patients was more pronounced...
Although physician reimbursement under Medicare is often cited as the reason why physicians turn away Medicare patients, our findings that more than 90% of physicians continue to accept Medicare patients despite marginal increases in reimbursement suggest that anecdotal reports may be overstating access problems.
The observed decline in acceptance of private noncapitated insurance was unexpected and could be related to reimbursement but also to administrative burden. Acceptance rates of capitated insurance was lower and may reflect lower reimbursement in this model. Finally, the low and declining acceptance of new Medicaid patients is not surprising given the program’s historically poor reimbursement rate. Low rates of Medicaid acceptance may threaten access to care for the estimated 16 million Americans who will receive Medicaid coverage as a result of the Patient Protection and Affordable Care Act.
Nobody in the press reporting the claims of those who insisted doctors were abandoning medicare patients en masse because of the prolonged fight over the "doctor fix" ever spent one second looking at whether it was true, let alone an anomaly. The headline should have been "Doctors opting out of private insurance".
