Medicare's 3-year-old physician fee schedule has, as intended, reallocated payments to primary-care physicians, according to HCFA Administrator Bruce Vladeck.
And while the system hasn't limited beneficiaries' access to care, such vulnerable populations as minorities, rural residents, and disabled and poor people still face more barriers to care than the general Medicare-eligible population, Mr. Vladeck said.
Speaking last week before a meeting of the American Public Health Association, Mr. Vladeck released a report showing that the Medicare physician fee schedule-called the resource-based relative value scale-caused a 10% increase in the average fee per primary-care physician between 1991 and 1992, to $41,039 from $37,362.
In contrast, the fees for specialists rose 2%, to $114,041 from $111,686. For surgical specialists, the fees declined 3%, to $94,082 from $97,020.
Despite concerns that the government pay scheme might limit access, the report indicated that access stayed the same or got better for most populations once HHS implemented the fee schedule. Some groups, such as blacks, rural residents, disabled people, beneficiaries older than 84, and people jointly eligible for Medicare and Medicaid, have more problems getting treatment than the general Medicare-eligible population, although HCFA data indicate some improvements in their access.
For instance, vulnerable populations tended to see physicians or get treatment for a health problem less frequently, receive treatments requiring referral to a specialist less frequently and be admitted to hospitals as the result of conditions that normally can be treated with continuing ambulatory care, the report said.
Black beneficiaries tended to get such treatments as heart and vascular surgery less frequently than whites, and they had a higher mortality rate afterward, suggesting that they were sicker when they received the treatment, said HCFA researcher Marian Gornick.
Mr. Vladeck said such indicators portend growing access problems in the future because of population growth patterns. The white Medicare-eligible population is expected to increase by 50% between 1990 and 2020, while the black population is expected to double and the Hispanic population more than triple.