This project will examine the impact of changes in Medicare payment to physicians on access to care for rural beneficiaries. If rural practices are threatened by the cumulative effects of reduced payment and increased expenditures, physicians may be forced to abandon the community to merge into larger urban-based practices, perhaps in other states. Access to primary care services would decline, and a vital contribution to the local social capital and economic development would be lost. This project will research the following hypotheses:

• Rural primary care physicians are more likely to declare policies not to see new Medicare patients than are urban primary care physicians or specialists (urban or rural).
• Rural primary care physicians are less likely to declare policies not to see new Medicare patients than are urban primary care physicians, due to the factor of "everybody knows everybody."
• Declines in seeing new Medicare patients will vary by region of the country, related to the percent elderly in the region, payment from other sources, and practice costs.

The primary reason physicians cease to accept new Medicare patients is the rate of payment; secondary reasons include complexity of the Medicare program, intensity of treatment needed for elderly patients, and personal preference.

Three completed surveys will be used to address these issues, with multiple regression analysis as the principal methodology used to analyze those data. In addition, a telephone survey will be conducted with a sample of state medical associations and state chapters of the American Academy of Family Medicine. Based on the telephone survey, three site visits will be made for the purpose of gaining a more in-depth understanding of the economic and other effects of treating a significant percentage of elderly patients on rural primary care practices.

Publications

• Rural Physicians' Acceptance of New Medicare Patients
  RUPRI Center for Rural Health Policy Analysis
  Date: 08/2004
  Findings are presented regarding rural physicians' acceptance of new Medicare patients from an analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians.