If You Measure Access Wrong, You’ll Get Policy Wrong

By Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC and Molly Siegel, MPH

The Medicare Payment Advisory Commission (MedPAC) recently released its latest views on access to care in the United States. The independent Congressional agency is advising that the federal government raise rates by 0.5% for the Medicare professional services fee schedule in 2027 - the schedule used most often in the ambulatory setting. The recommendation, MedPAC explains, “should maintain clinicians’ willingness to treat fee-for-service Medicare beneficiaries and maintain beneficiaries’ access to care.”

According to the assessments underlying this recommendation, Medicare beneficiaries are getting appointments quickly, clinicians are widely accepting new patients, and the overall access picture looks… fine. Nothing to see here.

Except that we know that is not true.

The operational reality inside ambulatory enterprises at our member health systems is very different. Backlogs are growing. Demand continues to outpace capacity. Patients navigate increasingly complex scheduling systems. Clinics are burning through every available lever just to keep up.

None of that shows up in MedPAC’s picture of access. And that is a problem.

Data Hide the Reality of Delay

Let’s unpack the assessment MedPAC is using to evaluate access to care in the U.S.

First, the headline statistic that 73% of patients are seen within two weeks lacks critical context. This figure includes established patients and may also capture lab visits, nurse visits, imaging, and other non-physician encounters. There is no breakdown by type of care—primary care versus specialty care, for example. Despite the importance of this finding, MedPAC does not provide that level of detail. This methodology is concerning.

Second, MedPAC reports that access is “good” for Medicare beneficiaries compared to patients with commercial insurance. As the report states, “Medicare beneficiaries were more likely than privately insured people to be seen within two weeks,” and “more Medicare beneficiaries than privately insured people reported that they got appointments when they needed them.” But if access is deteriorating for everyone, aren’t these comparisons misleading? And did our nation’s advisors overlook the fact that nearly one out of every three Americans relies on Medicaid or has no insurance at all?

Third, MedPAC leans heavily on what it calls the “key indicator of beneficiaries’ access to care”: the share of clinicians who accept Medicare and bill under the Medicare fee schedule. The agency reports that 95% of clinicians accept Medicare and that the number of participating clinicians continues to grow. While that may be accurate, the scale and market dominance of modern health insurers leave physicians with few viable alternatives outside of participation. This statistic may not be wrong—but is it relevant to whether patients can actually get timely care?

Finally, the conclusions rest largely on a “10-minute survey” of 10,000 patients described as “nationally representative.” Methodological details are not provided, but the survey is likely conducted by telephone and in English, raising questions about whether it truly reflects the national population. Further, it would be akin to setting national farm subsidies by surveying 10,000 grocery shoppers.

Although it is encouraging that MedPAC considered patient experience at all, flawed methodology and misguided inputs lead to conclusions that do not reflect the current state of ambulatory access.

These are interesting data points. But for them to help determine our nation’s payment rates for outpatient professional services? That is heart-stopping.

If you measure the wrong things, you will reach the wrong conclusions.

If Policymakers Think There Is No Problem, They Will Not Fix One

The stakes are high—and this is the dangerous part. MedPAC advises Congress. Their assessments shape future payment policy. Commercial payers follow Medicare reimbursement. Medicaid and uninsured patients are largely ignored.

If federal advisors conclude that ambulatory access is working well, there will be no structural correction at the national level. No push to invest in capacity. No incentive to improve our fractured infrastructure. No acknowledgment of the operational strain health systems face every day.

When national reports dismiss or overlook these realities, they minimize the patient experience and obscure the true state of ambulatory access.

In short, if MedPAC does not see the problem, it becomes harder for anyone else to solve it.

Until the measurements are corrected, the story will be wrong. And until the story is made right, neither will the policy.