Top Header Menu

Surprising Drop In Physicians’ Willingness To Accept Patients With Insurance

a doctor examining a patientAs required under the Patient Protection and Affordable Care Act of 2010, millions of people will soon be added to the ranks of the insured. However, this rapid expansion of coverage is colliding with a different, potentially problematic trend that could end up hampering access to health care. Since 2005, doctors have been accepting fewer and fewer patients with health insurance, according to a new study published in the June 27th issue of Archives of Internal Medicine.

As a result, says Dr. Tara Bishop, assistant professor of public health at Weill Cornell Medical College, and lead author of the study, insured patients could face new obstacles to receiving the medical attention they need, and overall access to health care could actually contract.

Dr. Bishop, who is also a practicing physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and her fellow investigators looked at survey data from a national survey run by the CDC’s National Center for Health Statistics and found an overall decline in physician acceptance of several types of insurance. First, they noted a modest drop in acceptance of Medicare patients, from 95.5 percent in 2005 to 92.9 percent in 2008. Doctors also turned more and more Medicaid patients away over the four-year period – a phenomenon the authors attribute to Medicaid’s historically low reimbursement rates. But the most surprising decline of all was seen in doctors’ acceptance of new patients with private insurance.

“Given the medical profession’s widely reported dissatisfaction with Medicare, we expected to find hard evidence that Medicare patients were being turned away,” Dr. Bishop says. “Instead, we saw only a modest decline in doctors’ acceptance of patients on Medicare. The survey data showed a more significant decline in their acceptance of patients with private insurance.”

Physician acceptance of patients with traditional fee-for-service private insurance declined from 93.3 percent in 2005 to 87.8 percent in 2008.

This change could be traceable to two major factors, she explains: inadequate reimbursement levels that have not kept pace with medical practice expenditures; and the tangle of administrative issues that go hand in hand with private health insurance.

“At a moment when the country is poised to achieve near-universal coverage, patients’ access to care could be a casualty of the collision between the medical profession and the insurance industry,” says Dr. Bishop.

The study was co-authored by Drs. Alex Federman of the Mount Sinai School of Medicine and Salomeh Keyhani of the University of California, San Francisco. The researchers hope their study will alert policymakers to potential problems in health care access, exacerbated by current shortages in primary care, an aging population, the growing prevalence of serious chronic diseases, and the imminent expansion of health insurance coverage as mandated under health care reform. “Consumers and health advocacy groups, too, should be aware of these early warning signs so that they can work to ensure access to quality medical care,” adds Dr. Bishop.

Material adapted from NewYork-Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College.

, , , ,

One Response to Surprising Drop In Physicians’ Willingness To Accept Patients With Insurance

  1. avatar
    Christopher Fisher, PhD July 1, 2011 at 7:22 AM #

    I am not sure why researchers are surprised that doctors are slowly not accepting private insurance (in addition to public insurance programs like Medicare/Medicaid). Are they that disconnected from the real world of doctors? The benefits of accepting insurance are few and the perils are many. Reasons include: reimbursement amounts ($) continue to be squeezed, mountains of paperwork, the need to hire a department of people to deal with insurance claims and reimbursements, insurance bureaucrats telling doctors how to manage patient care, slow or no reimbursement for previously approved care, and more. Where is the incentive for physicians to accept insurance?

    The latest tactics by insurance companies is to initially approve care, and then to later review this approval after care is completed and deny payment “after further review” because it is not a “covered service” (despite already approving it). The insurance company doesn’t have to pay the doctor, the patient receives care, and the doctor is stuck with the bill.

    Moreover, honest billing mistakes, usually related to diagnostic codes, have been criminalized by the government, and the insurance companies use legal methods to recoup payments when such an incident takes place – despite the physician providing legitimate care for a covered service.

    I have repeated this again and again, but the current healthcare crisis that involves both the insurance nightmare (public and private insurance) and obesity/diabetes/sedentary lifestyle epidemic cannot be fixed without a return to cash-based healthcare system. This will almost instantly address rising healthcare costs. Physicians and pharmaceutical companies will have to provide a product or service that the general public can afford or go out of business. Patients will be held accountable for personal lifestyle choices as those who make poorer choices will face increased costs in their care. Patients must be held accountable else healthcare costs can not, and will not, be brought under control.

    I hear of more and more doctors who stopped or plan to stop accepting insurance and returned to a cash-based system. Some have even created a “member only” practice whereby the doctor only accepts a limited number of patients who pay an annual fee (in additional to payment for services). This allows the doctor to take control of his or her practice (financial and treatment planning), charge reasonable cash fees-for-service, and to spend adequate time with each patient during their visit (because they do not have to see as many patients per hour) so that they can truly address all of the patient’s healthcare questions and needs.

Leave a Reply

* Copy This Password *

* Type Or Paste Password Here *

Proudly hosted by Lightning Base