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Vast Majority of PCPs Take Medicare, Despite Demise of Bonus

WASHINGTON, DC – The demise of the 10% bonus paid to primary care physicians who accept Medicare patients has raised concerns about how that will affect availability of care.

The incentive program, part of the Affordable Care Act, began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. According to a 2014 report by the Medicare Payment Advisory Commission (MedPAC), about $664 million in bonuses was distributed in 2012 to 170,000 primary care practitioners, for an average of slightly less than $4,000 per provider.

“Policymakers, researchers, and the media have periodically raised questions about the ease or difficulty that Medicare patients experience when trying to find physicians who will see them,” according to a recent Data Note from the Kaiser Family Foundation. “Previous studies show that the vast majority of physicians accept Medicare, but the proportion taking new Medicare patients is smaller, particularly among primary care physicians compared with specialists.”

This Data Note presents findings on reported acceptance of Medicare patients among non-pediatric primary care physicians, based on data from the Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers.

Results indicate that 93% of non-pediatric primary care physicians accept Medicare, similar to the 94% who accept private insurance. A high percentage, 72%, say that they are accepting new Medicare patients, although that falls short of the 80% who report they are willing to accept new privately insured patients.

On the other hand, just 67% say they accept Medicaid.

The Data Note points out that primary care physicians who indicate that they are not taking new Medicare patients could have “closed practices,” which were reported by 19% of respondents, and are taking no new patients, regardless of payment type.

A demographic analysis revealed differences in rates of acceptance of new Medicare patients, however, according to Kaiser. While 83% of primary care physicians who self-identify as Asian accept new Medicare patients, similar to the 86% among physicians who self-identify as either Black, Hispanic, or of another or multiple races, only 66% of White primary care physicians report doing so.

In terms of age, about two-thirds (67%) of primary care physicians age 55 or older say they accept new Medicare patients compared with about three-quarters (76%) of those younger than 55.

“Younger doctors may be more likely to be building their patient caseloads and, therefore, may be more willing to take new patients,” according to the Data Note. “Alternatively, older physicians may have fuller practices and have less capacity to accept new patients.”

The Kaiser report also points out that about one-third of non-pediatric primary care physicians (32%) report that at least half their patients have Medicare, with older, male doctors having the highest share of Medicare patients.