207959 Causes and potential cures for states with Medicare access problems

Sunday, November 8, 2009

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 Alaska senior populations, coupled with increasing numbers of physicians who either opt out of Medicare or see only established Medicare patients, has decreased access to primary-care services for this group.

One response to address this situation is to enhance financial incentives for primary-care physicians to increase their acceptance of Medicare beneficiaries. Another is to target increased support toward the safety net of community health centers.

To compare these two approaches, we developed a simplified demand and supply model of primary care in Alaska based on (1) our 2008 census of primary-care physician practices; (2) a review of community health center patient trend data; (3) emergency room patient trend data; (4) estimates of the net reimbursement rates for Medicare, Medicaid, private insurance, and self-insured payers and their relative ratios over time; and (5) a comparison of our Alaska demand and supply model estimates to a sample of other Western states selected for both high and low percentages of Medicare beneficiaries reporting “big problems” in finding a personal doctor or nurse. In Anchorage, 25% of primary-care physicians have opted out of Medicare; 56% are limiting Medicare access to their existing patients; and only 17% are accepting new Medicare patients. Interviews and review of trend data suggest that a significant factor behind limited and declining access for Medicare beneficiaries is that Medicare pays roughly 60% of the rate of private insurance for primary care in Alaska compared to roughly 70% in Washington State. Meanwhile, the Anchorage Neighborhood Health Center, a community health center, has seen the percentage of patients who are 65 and older more than double between 2001 and 2007—from 6% to 13.5%—while the Medicare beneficiary population visits to the hospital emergency room have remained flat.

Our preliminary findings suggest that, while targeting increased support toward the community health centers may be a more cost-effective way to sustain access than an across-the-board increase in Medicare reimbursement rates, a combination of enhanced support for critical access facilities and operations and a change in Medicare reimbursement measures may be needed to achieve a publicly acceptable level of access to primary care.

Learning Objectives:
1. Assess how much it would cost to achieve a publicly acceptable level of primary-care access for Medicare beneficiaries. 2. Develop a model that establishes determinants of primary-care physician participation in Medicare. 3. Describe the effects of different levels of reimbursement on primary-care physician participation in Medicare.

Keywords: Access and Services, Medicare

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 business consultant with experience in health economics, health care costs, and hospital issues. My past research has been on understanding Alaska’s health care costs and who is paying for it, and the uninsured. My current research interest include Medicare and community health centers.
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.