Good Health-Care News

More than half the doctors in California have agreed this year to accept the government-fixed fees for all of their Medicare patients. That is good news for older Americans who depend on the program for their basic health care.

There has been a remarkable increase in doctor participation in recent years, rising to 38.9% in 1987 to 48.5% in 1988, and to 54% this year, according to the Health Care Finance Administration. That increase was consistent with a national trend. This year 40.7% of the nation’s doctors are accepting assignment, compared with 37.3% a year ago. Even more significant is the fact that more than 80% of all Medicare physician spending is now at the approved rates.

This assures Medicare participants the largest selection of doctors accepting fixed fees since the program was launched. With these doctors, the patient makes only a 20% co-payment.

Nonparticipating doctors have two choices. They can charge what they like and ignore the Medicare system, in which case the patients pay the entire charge. Or they can selectively honor the Medicare insurance, collecting their own fees, but accepting an agreed ceiling on their fees if they are in excess of the regular Medicare fees.

For four years, through incentives, the federal government has been trying to encourage more doctor participation as a means of controlling spiraling costs. The effort to enlist more participating physicians is apparently successful. But cost controls remain elusive in the face of a pattern of increased utilization of both doctors’ services and costly diagnostic procedures.

The burgeoning demand for physician services is reflected in a new study, published in the current issue of Health Affairs, delineating trends from 1983 to 1986, when Medicare had a freeze on physician fees in place. Medicare expenditures to some physician specialties, calculated on a per beneficiary basis, showed remarkable increases, up 73% in those three years for gastroenterology, up 57% for ophthalmology. The rate of cataract surgery increased 50%, and, among diagnostic procedures, there was a 216% increase in sigmoidoscopy and a 120.5% increase in colonoscopy.

Even more stringent controls on doctors fees are now being developed upon recommendation of the Physician Payment Review Commission, appointed by Congress. A new payment plan is being developed, based on the relative value scale developed through federally mandated research led by William C. Hsiao at Harvard University. It will increase compensation for evaluation and management of health care, as in the diagnostic efforts of primary care physicians, including pediatricians, and reduce compensation for procedures, such as surgery, which currently consumes about one-third of the Medicare physician payments. The commission has concluded, however, that, in addition to fee reforms, controls will be needed on utilization of health care if costs are to be effectively contained.

Those on Medicare in Southern California can obtain a current listing of the doctors who accept assignment by calling (800) 381-6361.