Physicians at odds on Medicare reimbursement reform

Federman AD. Arch Intern Med. 2010;170:1735-1742.

Three-quarters of physicians polled said Medicare reimbursements are unfair, according to data from a national survey. However, there is little consensus on how to make reimbursement more equitable, the researchers found.

Between June 25 and Oct. 31, 2009, researchers surveyed 6,000 randomly selected physicians about reimbursement reform proposals. According to the researchers, physicians were asked to rank their support for the following items:

Reimbursement reform proposals.
Rewarding quality with financial incentives.
Bundling payments for episodes of care.
Shifting payments from procedures to management and counseling services.
Increasing pay to generalists.
Offsetting increased pay to generalists with a reduction in pay for other specialties.

The response rate was 48.5% (1,222 of 2,518 eligible individuals). More than three-quarters of the physicians practiced in office-based settings (77.2%). The mean age was 51.6 years and 73.1% were men. Eighty-two percent reported accepting Medicare.

According to the researchers, 78.4% of physicians who responded to the poll said Medicare reimbursements are inequitable, and this attitude did not vary considerably across specialties (P=.07). Nearly half of physicians who accepted Medicare (40.2%) strongly agreed that some procedures are compensated too highly and others are not compensated enough to cover loss.

The use of incentives to improve quality was the most popular of three reimbursement reform proposals (49.1% strongly or somewhat supported this approach). Physicians were split in support of the idea to shift payments (41.6% supported and 46.4% opposed). However, generalists were more in support of shifting reimbursement toward counseling and management compared with surgeons (66.5% vs. 16.6%; P<.001 for the difference across four specialties). The bundling of payments was opposed by more than two-thirds of physicians (69.1%).

Support for increasing pay for generalists was high, at 79.8% of respondents, and 76.6% of surgeons also expressed support. However, physicians in non-generalist specialties were less supportive of increasing pay for generalists, especially in the case of a cost offset.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes,” the researchers wrote. “Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending and improve health care quality will be difficult. Research that clarifies the tradeoffs physicians would be willing to accept in payment reform, and other concerns, may help refine the design of payment reforms and improve acceptance among physicians.”

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