Medicare Acceptance by Oregon Physicians

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Cornelius Wilkins
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1 Medicare Acceptance by Oregon Physicians Snapshot of Trends from the 2006 Oregon Physician Workforce Survey Office for Oregon Health Policy and Research

2 Percent Access to Physicians for Medicare Beneficiaries and Privately Insured People, Medicare Routine Care Illness or Injury Primary care Specialist Never had a delay to appointment Privately Insured No problem finding physician Source: MedPAC Report to the Congress: Medicare Payment Policy, March 2006, p. 85.

Injury Primary care Specialist Never had a delay to appointment Privately Insured 89 86 No

3 The majority of Oregonians are covered by employer-sponsored insurance (Population = 3.7 million) Uninsured 576,000 Medicaid 428,000 Medicare 547,000 Commercial 2,189, ,000 1,000,000 1,500,000 2,000,000 2,500,000 Source (Commercial): Oregon Insurance Division. Health Insurance in Oregon, January Includes individual, portability, small group, OMIP large group and self-insured coverage. Source (Medicare): Centers for Medicare and Medicaid Services. Source (Medicaid): Oregon Division of Medical Assistance Programs. Enrollment data as of October Source (Uninsured): Oregon Health Policy & Research. Profile of Oregon's Uninsured, August 2007.

Insurance Division. Health Insurance in Oregon, January 2007. Includes individual, portability, small group, OMIP large group and self-insured coverage.

4 Medicare enrollment has grown with the aging population Medicare enrollment, Oregon Oregon Medicare Enrollment 580, , , , , , , , Source: U.S. Department of Human Services, Centers for Medicare and Medicaid Services, Note, 2007 data reflects enrollment as of Jan All other years data is as of July of that year

2004 2005 2006 2007 Source: U.S. Department of Human Services, Centers for Medicare and Medicaid Services, 2008.

5 Oregon s 65+ population is increasing rapidly Projected percentage change in population 65+ years of age 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % 78% 26% 29% Oregon US Source: United States Department of Commerce, U.S. Census Bureau, Population Division; Census Data for Public Health Research, CDC WONDER On-line Database, March 2003 (1990 data) and September 2005 (projections).

6 Medicare physician payments are not keeping pace with practice cost inflation 25.0% Medicare Payments vs. Cost Inflation, U.S., % 15.0% 10.0% 5.0% 0.0% -5.0% -10.0% Practice cost inflation (MEI) Medicare physician payment update Sources: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of the Actuary, "Estimated Sustainable Growth Rate and Conversion Factor, for Medicare Payments to Physicians in 2009," Nov

0% 2001 2002 2003 2004 2005 2006 2007 2008 2009 Practice cost inflation (MEI) Medicare physician payment update So

7 Oregon leads country in Medicare Advantage enrollment * 40% Number of Medicare Advantage plan enrollees as a share of total Medicare beneficiaries 37.8% 35% 30% 25% 20% 18.5% 15% 10% 5% 0% OR *Puerto Rico has MA penetration rate of 53.3%; OR has highest rate of states US Source: Kaiser Family Foundation, Medicare Health and Prescription Drug Plan Tracker

5% 15% 10% 5% 0% OR *Puerto Rico has MA penetration rate of 53.

8 Oregon Physician Workforce Survey 2006

9 Acceptance of Medicare by Specialty All Specialties (n=2,601) 17.0% 12.3% 66.3% Psychiatry (n=176) 51.1% 12.5% 34.1% Neurosurgery (n=28) 21.4% 75.0% Surgical Subspecialty (n=214) 5.1% 11.2% 81.8% Medical Subspecialty (n=798) 6.5% 5.9% 85.3% General Surgery (n=107) 4.7% 4.7% 88.8% General Internal Medicine (n=367) 25.3% 11.4% 55.6% Ob/Gyn (n=209) 6.7% 14.4% 77.0% Family or general practice (n=685) 25.4% 20.6% 46.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Closed Open Completely closed Accept Medicare Advantage, but not FFS No limitations Limit both Medicare Advantage and FFS Accept FFS, but not Medicare Advantage * Excludes hospital-based

8% General Internal Medicine (n=367) 25.3% 11.4% 55.6% Ob/Gyn (n=209) 6.7% 14.4% 77.0% Family or general practice (n=685) 25.4% 20.6% 46.

10 Acceptance of Medicare by Region 2006 Oregon Workforce Survey Eastern (n=90) 12.2% 21.1% 64.4% Central (n=246) 16.3% 14.6% 65.9% Southern (n=288) 14.6% 11.8% 68.4% Southwestern (n=63) 12.7% 12.7% 66.7% Northwestern (n=67) 14.9% 6.0% 76.1% Mid-Willamette Valley (n=568) 20.2% 15.1% 60.9% Portland Metro (n=1,279) 17.1% 10.2% 67.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Closed Completely closed Accept MMC, but not FFS No limitations Open Limit both MMC and FFS Accept FFS, but not MMC * Excludes hospital-based specialties.

1% Mid-Willamette Valley (n=568) 20.2% 15.1% 60.9% Portland Metro (n=1,279) 17.1% 10.2% 67.

11 Acceptance of New Medicare Patients Oregon 2004 and % 20.7% 10.8% No limitations Restrict Completely Closed % 16.7% 17.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

12 Oregonians covered by Medicare are facing reduced access to primary care Oregon Primary Care Providers Not Accepting New Medicare Patients 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Source: Office for Oregon Health Policy and Research, 2004 and 2006 Oregon Physician Workforce Surveys, March 2005 and May 2007.

13 Primary Care Acceptance of New Medicare Patients Oregon and % 29.5% 13.3% No limitations Restrict Completely Closed % 23.6% 22.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

3% No limitations Restrict Completely Closed 2006

14 Factors in the Decision to Limit Medicare 2006 Oregon Workforce Survey Reimbursement 8.1% 10.0% 81.8% Patient load 38.0% 33.6% 28.5% Non-compliant patients 82.0% 14.1% 3.9% Liability insurance 71.1% 17.8% 11.1% Complex patient needs 43.8% 33.0% 23.2% Balancing payers 19.9% 22.5% 57.7% Admin requirements 20.6% 36.7% 42.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not important Somewhat important Very important

8% 11.1% Complex patient needs 43.8% 33.0% 23.2% Balancing payers 19.9% 22.5% 57.

15 Acceptance of New Medicaid Patients Oregon 2004 & % 39.1% 12.7% No limitations Restrict Completely Closed % 27.1% 21.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

16 Oregon Health Fund Board & its Federal Laws Committee s Medicare Recommendations Provide Legislative authorization for the Authority to pursue changes at the federal level: Equitable Medicare reimbursement Payment reform incenting primary care and better care coordination Expand Medicare Advantage HMO and PPO plans into all areas of the state

level: Equitable Medicare reimbursement Payment reform incenting primary care and

17 For more information: Oregon Health Fund Board Recommendations port_12_2008.pdf Federal Laws report available at: Federal_Laws_Report_Final_to_print.pdf 2006 Oregon Workforce survey hysicianfinalreport.pdf Questions: or

pdf 2006 Oregon Workforce survey http://www.ohpr.state.or.us/ohppr/rsch/docs/2006p hysicianfinalreport.

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