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A Project of The Annenberg Public Policy Center

Sen. Barrasso’s Medicare Mistake

Sen. John Barrasso mistakenly claimed that "57 percent of doctors don’t want new Medicare patients," which isn’t true. His own spokeswoman admits he got it wrong.

National surveys have put the number who don’t take new Medicare patients as low as 14 percent, and a big American Medical Association survey last year showed only 17 percent of all physicians said they were "restricting" Medicare patients (either taking none, or just some).

The Wyoming senator — who is also a physician — made his claim while discussing the current state of Medicare with CNN’s Candy Crowley on her Sunday morning program:

Barrasso, May 1: Plus, Candy, you know doctors right now are running away from Medicare. Many, many doctors, I think 57 percent of doctors don’t want new Medicare patients because the system we have right now is broken, it’s unsustainable. We have to fix it.

A spokeswoman said Barrasso made a mistake by referring to an April Forbes opinion piece about the Massachusetts health care law written by Sally Pipes, president of the Pacific Research Institute, a conservative think tank. That article referred only to one state — and had nothing to do with Medicare. It referred to Massachusetts doctors who are refusing to take any new patients, regardless of age. The author cited a statistic from Massachusetts Medical Society surveys that found "56% of physicians [not 57 percent] are not taking on new patients" in that state. But that’s not right. The 56 percent figure refers only to internal medicine doctors, in a 2009 survey

As for doctors across the nation who refuse or restrict new Medicare patients, the best surveys we could find all show much lower figures than Barrasso claimed.

  • A 2008 survey of more than 4,700 physicians by the Center for Studying Health System Change found that only about 14 percent accepted no new Medicare patients. Almost 74 percent accepted all or most new patients.
  • A September 2010 online survey of 516 family physicians conducted by the American Academy of Family Physicians found that more than 71 percent were accepting new Medicare patients.
  • A May 2010 online survey of more than 9,000 physicians conducted by the American Medical Association found that just 17 percent of all physicians said they were "restricting the number of Medicare patients in their practice." But "restricting" does not necessarily mean "not accepting" all new Medicare patients, according to AMA. It can include doctors who are taking only some new Medicare patients and refusing others.

That AMA survey — the largest we could find — also showed that for primary care doctors, 31 percent said they restricted Medicare patients.

The reason that some doctors refuse or restrict Medicare patients is that the system often pays them less than private sector insurance. And that problem could become worse if Congress cuts payments further. For example, in 2010, a survey conducted between April 28 and May 1 of 1,021 osteopathic physicians by the Benenson Strategy Group for the American Osteopathic Association found that 37 percent said they "probably or definitely would not" accept new Medicare patients in their practice if Medicare reimbursement payments to physicians were cut by 21 percent, as had been scheduled. That cut was averted, however.

Potential cuts in physician payments affected the results in the AAFP and AMA surveys last year as well. The AAFP survey from September found that almost 62 percent would stop accepting new Medicare patients if payment rates were cut by 21 percent. And the AMA survey from last May presented two different scenarios being considered by Congress at the time to address pending cuts. The results showed that 50 percent would stop taking new Medicare patients if there was up to a seven-month freeze on Medicare reimbursements with a 21 percent cut later, and 42 percent said they would stop if there was up to a five-year increase in Medicare payments with a 21 percent cut down the road.

Those projected cuts were a result of the sustainable growth rate formula, or SGR, that the Centers for Medicare and Medicaid Services uses to help determine payments to doctors for services provided to Medicare patients. The formula was adopted to help control health care spending, according to the Congressional Research Service:

CRS, Aug. 6, 2010: The SGR system was established because of the concern that the Medicare fee schedule itself would not adequately constrain overall increases in spending for physicians’ services. While the fee schedule limits the amount that Medicare will pay for each service, there are no limits on the volume or mix of services. The SGR system was intended to serve as a restraint on aggregate spending. If expenditures over a period are less than the cumulative spending target for the period, the update is increased. However, if spending exceeds the cumulative spending target over a certain period, future updates are reduced to bring spending back in line with the target. 

Congress has been blocking scheduled physician payment cuts since a reduction of almost 5 percent in 2002, according to CRS. At the end of 2010, Congress again passed legislation, which President Barack Obama signed into law, putting off a scheduled 25 percent cut in physician payments until January 2012. His proposed fiscal year 2012 budget would further delay scheduled cuts until the year 2014. "Looking beyond that, we are determined to work together to put in place a long-term plan to reform physician payment rates in a fiscally responsible way," the budget stated. CMS has said that doctors would face a nearly 30 percent cut in 2012 if Congress fails to act again.

So, Barrasso’s "57 percent" figure wasn’t based on a survey that looked at Medicare at all. And other surveys that actually looked at this issue found that a much lower percentage of doctors were not accepting new Medicare patients. But other surveys have shown that things could be as bad as Barrasso described if significant reductions in payments to doctors happen in the future.