A group with the Centers for Disease Control issued a brief report describing changes in physician office visits from 1998 to 2008. (CDC Report) During this time period, the percent of the population over age 65 held steady at 12%, but the percent aged 45-64 grew from 21% to 26% of the population, which reflects the looming aging of the population into Medicare eligibility. At the same time the percent of overall physician visits accounted for by persons over 65 went from 24% to 27% and for those in the 45-64 bracket, from 25% to 30%.
These numbers suggest that as the middle-agers become Medicare eligible, their need for physician visits will grow rapidly. The older age cohorts also account for more prescribing. The over 45 crowd is 38% of the total population but receives 70% of the prescriptions. This group also is responsible for 66% of all imaging. During the period of the study, annual doctor visits for the over 65 bracket rose from 6.1 to 6.9 per person. The biggest growth in visit causes was for hypertension, cardiac disrthymias and diabetes.
In 1978, 62% of physician visits by persons over 65 were to primary care doctors; by 2008 that number was down to 45%. At the same time, while overall 86% of physicians were accepting new Medicare patients, only about 80% of those in primary care fields were. This may reflect the power of the specialty groups in influencing the Medicare fee schedule, which generally has paid specialists much better than primary care doctors. Since specialists cost more not just in terms of their own charges, but in terms of other services they order, it is apparent that one significant cost control strategy for Medicare would be to raise primary care fees to entice more physicians to participate in Medicare, while reducing specialist fees. But to do that, CMS needs to take control of the fee schedule away from doctors and the AMA.