Using economies of scale, expectations under agency theory and cost-volume-profit concepts as a theoretical basis, this study will explore physicians’ perceptions of the impact of inadequate reimbursement to their practice, as well as the other underlying costs associated with Medicare including billing issues, audit concerns, capacity constraints and overall clinical burden. Drawing from a recent sample of practicing physicians, this study will employ a quantitative survey approach to explore national perceptions concerning three different physician practice organizational models: 1) sole proprietorships/two-physician practices, 2) group practices and 3) institutions. As physicians perform clinical services in a variety of different organizational models, of differing size, scope and ownership, it may prove telling to explore the issue from their unique position. This study aims to explore just that.
Data/Methods:
A 2008 national survey of physicians known as the Health System Change’s Health Tracking Physician Survey will provide the data from which to explore the research questions.
The focus will be to examine whether physician practice models do or do not differ with respect to the perceived impact on the practice of the underlying cost of accepting new Medicare patients. To test this, it is the writer’s null hypothesis that perceived impact is independent of physician practice type.
A chi-squared test will be employed in analyzing the reasons that physicians limit new Medicare patients. The questions addressed herein will fundamentally be that of whether the perception of the particular underlying “cost” differs among the three examined physician practice types (sole practitioner/two physician practice, a group practice and institutions). The null hypothesis reflects that there is no association between the two variables, while the alternate is that there is an association between the two variables.
Expected Results:
Each of the five null hypotheses will be rejected.
HO 1: Limiting acceptance of new Medicare patients for reason of inadequate reimbursement is independent of physician practice type.
HO 2: Limiting acceptance of new Medicare patients for reason of billing issues is independent of physician practice type.
HO 3: Limiting acceptance of new Medicare patients for reason of concern about a Medicare audit is independent of physician practice type.
HO 4: Limiting acceptance of new Medicare patients for reason of capacity constraints such that the practice already has enough patients is independent of physician practice type.
HO 5: Limiting acceptance of new Medicare patients for reason of high clinical burden is independent of physician practice type.
Discussion:
The nature of this study is considered timely for reason that the pool of new Medicare patients is expected to grow dramatically and several sources are beginning to report that doctors are refusing new Medicare patients and this may become a problem.
With limited empirical research dealing with the contemporary phenomenon of US based physicians limiting their acceptance of new Medicare patients; it is the writer’s objective to provide for a basis on which to examine the issue, in particular that from the perspective of the physician practice type.