Physicians To Congress: Fix Broken, Unfair Medicare System Now

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 13 Jun 2008 - 4:00 PDT

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The clock is running out for Congress to address a double-digit pay cut to physicians who care for Medicare patients. The 10.6-percent cuts will slice into the program July 1, potentially leaving many senior citizens without a doctor.

However, one piece of legislation could stop the cuts, but it needs to pass the U.S. Senate immediately. A vote is scheduled today to begin floor consideration of Senate Bill 3101, the "Medicare Improvements for Patients and Providers Act," introduced by Senate Finance Committee Chair Max Baucus (D-MT). The bill would halt the pay cuts. The Texas Medical Association (TMA) and Texas physicians believe the reprieve will protect patients while buying time to develop a rational, long-term solution.

If not, Medicare cuts will squeeze more doctors out of the program, so many patients will face greater difficulty finding a physician to care for them, according to the most recent TMA physician survey. Only 58 percent of Texas physicians surveyed said they accept all new Medicare patients. If the problem does not get fixed, more than 42 percent of Texas doctors would consider opting out of the Medicare program altogether.

"If there was a 10-percent Medicare cut, you can't imagine the [physician] exodus from Medicare that would happen,'" says Lisa Ehrlich, MD, a TMA physician leader practicing internal medicine in Houston.

Congress has faced repeated annual deadlines to address physicians' payments from Medicare. However, each year for the past five years, Congress has found ways to avoid fixing the crux of the problem - the flawed payment formula used to calculate their payments.

To find the money to care for more Medicare patients, physicians and some members of Congress want to draw from a "cash cow": Medicare Advantage private insurance company health plans. Medicare Advantage does not help patients but instead wastes precious dollars brokering existing health care services. Medicare Advantage's private health plans spend more money on administrative costs than traditional Medicare.

For every Medicare patient Dr. Ehrlich treats, she already loses money, so she has to be selective. She cannot afford to accept new Medicare patients with whom she has no established patient-physician relationship. Medicare insures 15 to 18 percent of her patients. She created the delicate balance to care for as many Medicare patients as possible yet still survive as a physician. Though difficult, she says she her only choice is to limit the number of Medicare patients she treats.

While physicians face annual payment cuts, other health care providers for Medicare patients - hospitals, nursing homes, pharmaceutical companies, and Medicare Advantage plans - receive annual payment increases. They payment schedules are calculated using a different method than the one used for physicians.

Dr. Ehrlich's forecast is glum. "The whole Medicare system is going to break," she says. "I'm no mathematician but I can tell you, baby boomers are going to break the system." The first baby boomers will age into Medicare eligibility in three years.

TMA is the largest state medical society in the nation, representing more than 43,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. Organized in 1853, TMA's key objective is to improve the health of all Texans.

Texas Medical Association

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