United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1999-02-26 monographic deposited born digital 38 p. GA 1.13:HEHS-99-36 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-36 P0b002ee18039998b f:he99036 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-99-36 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-36 HEHS-99-36 Health care programs Internal controls Cost effectiveness analysis Physicians Medical fees Health care services Performance measures Medicare Incentive Payment Program Letter Report HEHS

Pursuant to a congressional request, GAO reviewed the Medicare Incentive Payment program to determine if: (1) it is an effective mechanism for improving access to care for Medicare beneficiaries and underserved populations other than Medicare beneficiaries; and (2) the program's goals, performance measures, and financial controls provide a sound structure for continuing or expanding the program.<p/>GAO noted that: (1) the Medicare Incentive Payment Program is not an effective mechanism for improving Medicare beneficiaries' ability to obtain health care; (2) the program was created out of concern that low Medicare payment rates for primary care services, particularly in areas with a shortage of physicians, could cause access problems for Medicare beneficiaries; (3) however, since the program began, Congress has taken additional action to address this concern; (4) this action generally increased reimbursement rates for primary care services and reduced the geographic variation in physician reimbursement rates; (5) in addition, the Health Care Financing Administration (HCFA) survey data show that Medicare beneficiaries who have access problems, including those who may live in underserved areas, generally cite reasons other than the unavailability of a physician--such as the cost of services not paid by Medicare--for their access problems; (6) the Medicare Incentive Payment program is also not an effective mechanism for improving access to care for people not covered by Medicare in underserved areas; (7) although the program is considered a means of attracting and retaining physicians in shortage areas, the program does not appear to play a significant role in this regard; (8) the relatively small bonus payments most physicians receive--a median payment of $341 for the year in 1996--are unlikely to have a significant impact on physician recruitment and retention; (9) the program has two other severe limitations that restrict its ability to address identified needs of those in underserved areas; (10) specialists receive most of the program dollars, even though primary care physicians have been identified as being in short supply, while shortages of specialists, if any, have not been determined; (11) the program provides no incentives or assurance that physicians receiving bonuses will actually treat people who have problems obtaining health care; (12) the Department of Health and Human Services (HHS) has not developed goals or related performance measures for the Medicare Incentive Payment Program to clarify what the program is expected to accomplish; (13) without such goals and measures, it is difficult for HHS to determine what the program is accomplishing; and (14) HCFA's oversight of the program also has limitations that allow physicians and other providers to receive and retain bonus payments they claimed in error. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-36/html/GAOREPORTS-HEHS-99-36.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-36/pdf/GAOREPORTS-HEHS-99-36.pdf GAO/HEHS-99-36 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-36 Letter Report GAO/HEHS-99-36; Physician Shortage Areas: Medicare Incentive Payment Not an Effective Approach to Improve Access; Health care programs Internal controls Cost effectiveness analysis Physicians Medical fees Health care services Performance measures Medicare Incentive Payment Program Title 42 Section 1395l(m) Title 42 Section 1395w-4 42 U.S.C. 1395l(m) 42 U.S.C. 1395w-4 Volume 101 Page 1330 101 Stat. 1330 Volume 103 Page 2106 103 Stat. 2106 Public Law 100-203 Public Law 101-239