Access to Physician Services

Several recent surveys of Medicare beneficiary access to physician  services have not identified major access issues. Small percentages of Medicare beneficiaries reported never easily  obtaining appointments; measures of beneficiaries receiving physician  services increased nationwide from 2000 to 2008; and indicators of  physician willingness to serve Medicare beneficiaries and to accept  Medicare fees as payment in full also increased from 2000 to 2008. From 2000 through 2008, the proportions of beneficiaries receiving  services in April varied by state urban and rural areas. Potentially Overserved Areas Tend to Be in More Densely Populated Urban Regions and the Eastern Part of the Country

Potentially overserved areas tend to be the more densely populated urban  regions. Beneficiaries residing east of the Mississippi River are much more likely   to reside in a potentially overserved area, because the most densely  populated areas in the east are more likely to be potentially overserved  than are those in the west. Potentially Overserved Areas Are Largely Similar to Other Areas, with the Exception of Physician Practice Patterns

Potentially overserved areas and other areas are largely similar in  characteristics that could drive the use of physician services, including  demographic characteristics and the capacity to provide health care  services. In contrast, certain types of physician services are performed  more frequently in potentially overserved areas than in other areas,  suggesting differences in physician practice patterns. Agency and Industry Comments and Our Evaluation

		Agency Comments

In written comments on a draft of this report, CMS noted the agency’s  longstanding practice of monitoring the effect of policy changes on  beneficiary access to Medicare services, and stated that this report would  help in that effort. As we reported in  our draft, we found very few beneficiaries reporting major access  difficulties in 2007 and 2008, the utilization of services increased  nationwide from April 2000 to April 2008, and physician participation in  Medicare also rose over this period. Specifically, we wanted to (1) determine  how beneficiary access to physician services has changed from 2000 to  2008; (2) identify areas of the country where Medicare beneficiaries are  potentially overserved by physicians; and (3) describe characteristics that  distinguish potentially overserved areas from other areas in the nation. We constructed  multiple utilization measures to determine whether Medicare beneficiaries  experienced changes in their access to physician services; these indicators  included  the percentage of Medicare FFS beneficiaries obtaining services in April of  each year and the number of physician services per 1,000 beneficiaries who received  services. We also compared beneficiary satisfaction with their health care  and the types of physician services provided in the two types of areas. We assessed the reliability of the U.S. Census  Bureau and ARF data by reviewing relevant documentation and examining  the data for obvious errors.
Why GAO Did This Study

Congress, policy analysts, and groups representing physicians have raised questions about beneficiary access to Medicare physician services. At the same time, high levels of spending for health care in some parts of the country, and rapid increases in spending for physician services, have been identified as factors that threaten the long-term fiscal sustainability of the Medicare program. GAO was asked to assess beneficiary access to physician services and to identify indicators of potential overutilization of physician services. In this report, GAO (1) examines whether, from 2000 through 2008, beneficiaries had problems accessing physician services; (2) identifies areas of the country in which Medicare beneficiaries are potentially overserved by physicians; and (3) describes characteristics that distinguish the potentially overserved areas from other areas in the nation. GAO analyzed the most recent data available from several sources, including an annual Centers for Medicare & Medicaid Services (CMS) survey of fee-for-service (FFS) Medicare beneficiaries, Medicare physician claims for services provided in April of each year from 2000 through 2008, the Health Resources and Services Administration's Area Resource File, and the U.S. Census Bureau.

What GAO Found

GAO found that Medicare beneficiaries experienced few problems accessing physician services during its period of study. Very small percentages of Medicare beneficiaries--less than 3 percent--reported major difficulties accessing physician services in 2007 and 2008. The proportion of beneficiaries who received physician services and the number of services per beneficiary served increased nationwide from April 2000 to April 2008. Indicators of physician willingness to serve Medicare beneficiaries and to accept Medicare fees as payments in full also rose from 2000 to 2008. Potentially overserved areas--areas that were in the top half in both the level and growth in utilization of physician services--tend to be in the more densely populated urban regions and the eastern part of the United States. Large metropolitan areas were much more likely to be potentially overserved than rural and small metropolitan areas. Areas east of the Mississippi River were also more likely to be potentially overserved than those in the west. Potentially overserved and other areas are similar in demographic characteristics and the capacity to provide health care services. The two groups are also similar in Medicare beneficiary satisfaction with health care. In contrast, certain types of physician services, such as advanced imaging and minor procedures, are performed more frequently in potentially overserved areas relative to other areas, suggesting differences in physician practice patterns. In commenting on a draft of this report, CMS noted the agency's longstanding practice of monitoring the effect of policy changes on beneficiary access to Medicare services, and stated that this report would help in that effort.