For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors’ access show that the vast majority enjoy good access to care.

For instance, in May of this year, the Medicare Payment Advisory Commission (MedPAC), which advises Congress on payment policies, published the results of focus groups of physicians and beneficiaries. It reported that neither beneficiaries nor physicians believe that there are widespread access problems for beneficiaries.

Views of beneficiaries:

“We heard few concerns about access to physicians in any of the three locations selected for this study … Most beneficiaries felt they could get appointments in a reasonable amount of time as appropriate to the medical situation. For the most part, access issues do not appear to have changed for these beneficiaries over the past several years. Most beneficiaries have no trouble finding doctors, but there were a few more reports of issues with access to specialists than for primary care.”

Views of physicians:

“Most physicians were accepting new Medicare patients, but a few were not. All physicians were required to have at least 10 percent Medicare patients in their practice to be invited to one of our focus groups, but a few reported that they had stopped taking new Medicare patients. A few others have given serious consideration to stopping … Physicians see Medicare as a reliable payer, and appreciate the lack of preapproval requirements.”

The focus group findings mirrored surveys of beneficiaries, also commissioned by MedPAC. “In 2006 – the most recent year for which we [MedPAC] have data from the Medicare Current Beneficiary Survey – more than 90 percent of beneficiaries reported good access to care, regardless of the question asked.” Moreover, Medicare beneficiaries’ reported access was better than for privately-insured persons. The same survey, though, did show that there may be a growing (but relatively modest) problem with beneficiary access to primary care:

“Of the 6 percent of Medicare beneficiaries who were looking for a new primary care physician in 2008, 28 percent reported problems finding one. Although this amounts to less than 2 percent of the total Medicare population reporting problems, the Commission is concerned about the continuing trend of greater access problems for primary care.

Maggie Mahar, blogging in Health Beat, also casts doubt more on the notion that a large number of doctors are boycotting Medicare. Citing the MedPAC surveys and other data, she notes that there is palpable “anxiety” among physicians, “The take-away message is that while the 21% cuts doctors are now facing are an administrative nightmare, they will be fleeting. And reports of a mass exodus by doctors from Medicare are overblown.”

She may be right that there isn’t a “mass” exodus from Medicare – yet.

But something tells me that this time, things may be different. The latest cut and the chaos it creates may have reached a tipping point. An ACP member from Georgia told me that it wasn’t until yesterday that her practice received the first check from Medicare (with the 21% cut included) since the first of the month, and that as a result, her practice is living off credit and having trouble making ends meet. She predicted that she, and many others, will soon have no choice but to close their primary care practices if Medicare can’t be counted on to pay its bills.

But it more than money, I think, that is behind more and more physicians giving thought to what in the past was unthinkable: finding a way to make a living that doesn’t involve Medicare. It is a matter of the government breaking the bond of trust between doctors and the program. Trust that they government will pay them fairly, and on time, for their services, in exchange for physicians honoring their commitment to provide seniors with the best care possible. And as any cuckolded spouse can tell you, once a bond of trust is broken, it is almost impossible to restore.

Do you think the latest SGR debacle will create an access “tipping point” for patients?

Bob Doherty is Senior Vice President of Governmental Affairs and Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.

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