207762 Declining access to primary care for Medicare beneficiaries in Alaska

Wednesday, November 11, 2009: 8:45 AM

Rosyland R. Frazier, MS , Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, AK
Mark Foster , Mark Foster and Associates, Anchorage, AK
     
Rapid growth in senior populations, coupled with reports of increasing numbers of physicians who either opt out of Medicare or see only established Medicare patients, may lead to a shortage of primary-care services for this group.

To evaluate the problem, this project measured primary-care physicians' acceptance of Medicare beneficiaries and Medicare reimbursement and explored why they made those choices. We conducted and analyzed a structured telephone interview of primary-care physicians, supplemented with a review of relevant literature, reports, and secondary data as well as key informant interviews.

From Alaska's 709 licensed primary-care providers, we identified just 264 practicing general, family, and internal medicine physicians who could potentially provide direct services to Medicare beneficiaries. We interviewed 232 of these (88%). Acceptance of Medicare patients varied around the state, with Anchorage (pop. 260,000) having the largest potential problem. Among Anchorage's 75 physicians, 20 had opted out of Medicare (27%), compared to a national aggregate average of 3.4% from the Center for Studying Health System, Change Community Tracking Study Physician Survey (2004-2005); an additional 42 would only accept Medicare reimbursement for their established patients (56%). Just 13 would accept Medicare reimbursement for new patients (17%). Our respondents most often cited inadequate reimbursement as their reason for limiting or not accepting new Medicare patients.

In 2004, the Center for Medicare and Medicaid Services, Consumer Assessment of Healthcare Providers and Systems Survey, found that 15% of Medicare beneficiaries in Alaska reported “big problems” finding a personal doctor or nurse. We speculate that figure may be on the order of 20% in 2008, based on a simple trend projection.

Based on current trends—including physicians opting out of Medicare and otherwise limiting access, as revealed by our census combined with rapid growth in the population over 65—we expect that a rapidly growing population of seniors in Anchorage will be increasingly challenged to find affordable access to primary-care services over the next decade.

Learning Objectives:
1. Recognize the implications of primary-care physicians limiting Medicare beneficiaries and the options these patients have for alternative providers of primary care. 2. Delineate where access to primary care for Medicare beneficiaries is limited. 3. Describe primary-care physicians’ reasons for accepting or limiting new and established Medicare patients.

Keywords: Medicare, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because I am a research associate with broad experience in public health issues. I am a former executive director of the Anchorage Neighborhood Health Center and have worked at other community health centers and within a health maintenance organization. My current research includes health care costs, coverage issues, and health services delivery.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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