Physicians agree Medicare reimbursement is flawed, disagree on how to reform it

October 25, 2010

A national survey finds most physicians believe Medicare reimbursement is inequitable, but there appears to be little consensus regarding proposed reforms, according to a report in the October 25 issue of Archives of Internal Medicine.

"Across the political spectrum, there is general agreement that the cost of health care has risen to untenable levels and is threatening the future of Medicare and the economic well-being of the United States," the authors write as background information in the article. Clinicians account for one-fifth of , but because their patterns of use drive other expenses, many proposals for reform have focused on clinician reimbursement as a target to promote cost savings while improving care. Strategies that have been proposed include financial bonuses for meeting quality standards, financial penalties for providing substandard care, bundling payments for episodes of care into a fixed amount and the promoting of accountable care organizations.

Alex D. Federman, M.D., M.P.H., of Mount Sinai School of Medicine, New York, and colleagues conducted a national survey of randomly selected physicians between June 25 and Oct. 31, 2009. Participants were asked whether, under the current Medicare reimbursement system, some procedures were reimbursed too highly and others at rates too low to cover costs. They then rated their support for several reform proposals.

Of 2,518 eligible physicians who received the survey, 1,222 (48.5 percent) responded. Four of five clinicians (78.4 percent) agreed that current was inequitable. However, "there was little unity regarding support for physician payment reform proposals," they write.

Among the reform options, participants were most likely to support financial incentives for quality care (49.1 percent). "Actual experience with to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms," the authors write.

Overall, 41.6 percent of participants supported shifting payments from procedures to management and counseling services, but there was even less consensus on this proposal. For instance, 66.5 percent of generalists supported it compared with 16.6 percent of surgeons. "As expected, those who conduct procedures were against it, and those who do more management and counseling were for it," they continue.

Most physicians from all specialties (69 percent) were opposed to bundling. Surgeons, who may have the most experience with this strategy, expressed the lowest level of support (15.2 percent). Conversely, most physicians (79.8 percent) supported increasing pay for generalists and only 13.3 percent opposed this strategy. However, few (39.1 percent) would agree to offset this increase with a 3 percent reduction in specialist reimbursement.

"Overall, physicians seem to be opposed to reforms that risk lowering their incomes," the authors conclude. "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."

More information: Arch Intern Med. 2010;170[19]:1735-1742

Related Stories

Recommended for you

Experts devise plan to slash unnecessary medical testing

October 17, 2017
Researchers at top hospitals in the U.S. and Canada have developed an ambitious plan to eliminate unnecessary medical testing, with the goal of reducing medical bills while improving patient outcomes, safety and satisfaction.

New study: Nearly half of US medical care comes from emergency rooms

October 17, 2017
Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered ...

No evidence that widely marketed technique to treat leaky bladder/prolapse works

October 16, 2017
There is no scientific evidence that a workout widely marketed to manage the symptoms of a leaky bladder and/or womb prolapse actually works, conclude experts in an editorial published online in the British Journal of Sports ...

Ten pence restaurant chain levy on sugary drinks linked to fall in sales

October 16, 2017
The introduction of a 10 pence levy on sugar sweetened drinks across the 'Jamie's Italian' chain of restaurants in the UK was associated with a relatively large fall in sales of these beverages of between 9 and 11 per cent, ...

New exercises help athletes manage dangerous breathing disorder

October 16, 2017
A novel set of breathing techniques developed at National Jewish Health help athletes overcome vocal cord dysfunction and improve performance during high-intensity exercise. Vocal cord dysfunction, now also referred to as ...

Learning and staying in shape key to longer lifespan, study finds

October 13, 2017
People who are overweight cut their life expectancy by two months for every extra kilogramme of weight they carry, research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.