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Medicare Fact Sheet

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  • The fastest growing segment of the U.S. population is over 85 years of age.i
  • Elderly patients are more likely to have chronic medical conditions and to develop complications when they are in the hospital, such as when they get the flu.ii
  • As the nation’s population ages, Medicare resources will be needed to meet their emergency care needs.
  • Every year Congress averts the cuts to Medicare doctors, but the Medicare physician payment formula must be fixed, because it is based on a flawed formula (SGR)iii and does not reflect actual physician costs of providing medical care.
  • If Medicare is cut, then many doctors will not treat Medicare patients.iv These patients will seek care in the nation’s emergency departments. Sequestration may further reduce the number of physicians seeing new Medicare patients.

Q. How many Medicare patients visit the emergency department?

  • Nearly 20 million patients ages 65 and older received emergency care in 2009.v
  • The top reasons for seeking emergency care are chest pain, shortness of breath and stomach pain or cramps.vi

Q.  What kind of Medicare cuts are proposed?

Federal law requires the Centers for Medicare & Medicaid Services (CMS) to cut the Medicare physician payment update for 2014 by at least 25 percent unless Congress intervenes. CMS has projected as much as 40 percent in cuts over several years.

Q. How will Medicare cuts affect the ability of emergency physicians to care for Medicare patients?

  • According to the March 2013 annual report of the Medicare Payment Advisory Commission (MedPac), “While 96 percent of U.S. doctors participate in Medicare, only 73 percent of primary care doctors are accepting new patients under the program.” Coverage does not equal access to medical care.
  • Physician payment cuts through sequestration may further reduce the number of physicians taking new Medicare patients. That means more seniors will seek medical care in emergency departments. Emergency physicians are proud to serve as a vital part of the nation’s health care safety net. However, hundreds of emergency departments have closed in recent years because they can’t afford to stay open. This is reducing the nation’s capacity to provide lifesaving emergency care to all patients. Half of emergency care services go unpaid, according to the federal government,vii and declining payments from the government and private health plans are threatening the ability of emergency physicians to provide care.

Q. What does ACEP propose to solve this problem?

  • ACEP is working with members of Congress and other physician groups to develop and support legislation to replace the SGR formula in 2013.
  • ACEP supports eliminating the fundamentally flawed Sustainable Growth Rate formula used to reimburse physicians for providing Medicare services and replacing it with a system that accounts for the rising costs of providing medical care, as recommended by MedPAC.viii ACEP agrees with MedPAC that the annual physician payment updates must be sufficient to maintain Medicare beneficiaries’ access to care.
  • ACEP members are working with hospitals and community physicians to reduce hospital readmissions, which results in better care coordination for patients and fewer penalties for hospitals.

For more information, visit www.acep.org

[i] U.S. Census Bureau. 2010. “Age and Sex Composition: 2010” http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

[ii] Centers for Disease Control and Prevention. “People at High Risk of Developing Flu-Related Complications.” 2012. http://www.cdc.gov/flu/about/disease/high_risk.htm

[iii] American Medical Association. “Medicare Physician Payment System.” October 15, 2009. http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-rebasing-sgr-eliminate-paygo.pdf

[iv] American Medical Association Survey. “The Impact of Medicare Physician Payment on Seniors’ Access To Care.” May 2010. http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-survey-results-0510.pdf

[v] CDC. National Center for Health Statistics. 2012. “National Hospital Ambulatory Medicare Care Survey: 2009 Emergency Department Summary Tables.” Table 2. http://www.cdc.gov/nchs/fastats/ervisits.htm

[vi] CDC. National Center for Health Statistics. 2012. “National Hospital Ambulatory Medicare Care Survey: 2009 Emergency Department Summary Tables.” Table 2. http://www.cdc.gov/nchs/fastats/ervisits.htm

[vii] CMS Physician Fee Schedule Final Rule 12/31/2002.

[viii] Medicare Payment Advisory Commission. “Report to the Congress: Medicare Payment Policy.” March 2013  http://www.medpac.gov/documents/Mar13_EntireReport.pdf


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