Despite Medicare reimbursement cuts and a chorus of complaints from physician groups, doctors are still accepting Medicare patients at the same rate, according to a study by the Center for Studying Health System Change. But doctors say that without a reimbursement fix, it's only a matter of time until doctors start closing their doors to new Medicare beneficiaries. Almost 73 percent of doctors said they were accepting new Medicare patients in 2004 and 2005, up slightly from 71 percent in 2001; among family physicians, the increase was even greater, to 65.3 percent from 61.7 percent. This is in spite of a 5.4 percent cut in reimbursements that took place in 2002; that rate cut was largely reversed by increases in reimbursements from 2003-2005, the Center said. "Despite fluctuations in both Medicare physician payment and access during the past 10 years, Medicare beneficiaries' access to physicians remains high and is on par with physician access for privately insured patients, even though Medicare payment rates average about 20 percent less than private insurance rates," said HSC senior researcher Peter J. Cunningham, PhD, coauthor of the study along with HSC health research analyst Andrea Staiti and Paul B. Ginsburg. But Dr. Larry Fields, a family practice doctor who is president of the American Academy of Family Physicians, said that further Medicare cuts are burdening doctors even more. Patients are likely to see access to doctors tighten up if the cuts continue. "We have a catchphrase called 'Fields' physics': Payment minus overhead equals access," Fields said. "If the right side of the equation turns red, the system can only stand that for so long." He also said that AAFP, on behalf of United States family doctors, had pledged last fall to stand by their Medicare patients regardless of cuts. He attributes the high percentage of Medicare patient acceptance to loyalty, not satisfaction with the reimbursement schedule. "I think that's what the survey shows," Fields said. "It shows that family doctors stood by their patients in the face of governmental action that you'd think would drive people away. We didn't. These people are our friends, our parents, our longtime patients." The Center's study showed that the increase in acceptance of Medicare patients among primary-care doctors may stem from increases in acceptance by the doctors who earn least, less than $120,000 a year. For these doctors, Medicare acceptance grew sharply, to 72.2 percent from 65.5 percent. Though Congress backed off of a scheduled 4.4 percent rate cut for 2005, it froze rates, resulting in an effective rate cut because of inflation. Future cuts are still scheduled and are expected to be deeper than 4.4 percent. According to a survey by the American Medical Association, 38 percent of physicians said that the 4.4 percent cut scheduled for 2006 would have forced them to decrease the amount of new Medicare patients they accepted. "By freezing payments at 2005 rates, Congress has stopped the 2006 cut of 4.4 percent, which the Medicare trustees predict is the harbinger of six straight years of physician payment cuts totaling 26 percent," said Dr. J. Edward Hill, AMA president. "With six years of cuts still scheduled to come as practice costs continue to rise – we fear more physicians will make difficult practice decisions about treating Medicare patients." Indeed, the Center's study showed that 70 percent of doctors who chose to stop accepting new Medicare patients cited payment rates as a moderately or very important reason behind that choice. Paperwork was the factor cited next most often. But Cunningham said in a statement that the biggest risk to seniors' access to doctors might not be the "stagnant Medicare payment levels." The number of privately insured patients is dropping, and the number of uninsured and Medicaid patients is growing, and these trends may catch doctors – and in turn, their patients – in a pinch. "Continued financial pressure will compel physicians to limit patients that generate little or no revenue – Medicaid and uninsured patients," Cunningham said. The AMA and AAFP want Congress to revamp the formula that determines doctors' Medicare payments. "The current payment formula is tied to the ups and downs of the U.S. economy – not the growing health care needs of America's seniors," Hill said. "We must build on the momentum and awareness raised in 2005 to make 2006 the year Congress permanently repeals the broken Medicare physician payment formula." The Center's president, Paul Ginsburg, agreed. "Although Medicare beneficiaries' access to physicians has stabilized, access problems could emerge over time without changes in the Medicare physician payment formula," he said. "If the status quo continues, Congress will face a trade-off of uncontrolled physician spending or risking access problems for Medicare beneficiaries." Fields said that, to fix Medicare payments for the long term, the so-called Sustainable Growth Index – which changes from year to year, and was designed to cut Medicare costs – should be replaced by the Medical Economic Index formulated by an advisory group to the Center for Medicare and Medicaid. The latter index accounts for actual practice expenses, he said. "Unless the gas company, the electric company, the medical liability company, and the lawyers operate on a growth index, the math doesn't work," he said. "We're trying our best to get legislators to do the right thing for their constituents and fix the formula. If Congress doesn't do something about it this year, they're likely to suffer some ballot shock at election time." Of the 2006 rate freeze, Fields said, "It's a Band-Aid solution. We've already lost a month of payments, and even though we'll get that money back, it will take six or seven months." The rate freeze was enacted February 1. In January, the Department of Health and Human Services pledged to reprocess any Medicare claims filed in January, rather than requiring doctors to resubmit their claims under the new rate scheme. But that reprocessing is expected to take months; HHS has set a deadline of July 1.