Opinion: Seniors Are Losing Access to Medicare Doctors

(June 22) -- In March, Washington looked America squarely in the eye and promised the $1 trillion health care overhaul would reduce the deficit and save Medicare. Moreover, our political leaders assured seniors they could keep their physician. Now reality sets in. None of this was true.

When lawmakers said the Patient Protection and Affordable Care Act would cut the deficit by $143 billion over the next decade, what they left out was the fact that these savings depended on deep cuts in payments to doctors treating Medicare patients -- cuts so deep they'd severely limit seniors' access to doctors.

Lawmakers then promised doctors they'd undo these payment cuts in a separate "doc fix." But lawmakers, facing massive deficits, haven't yet lived up to that end of the bargain, and patients are already feeling the pinch.

A USA Today story published Monday found that "the number of doctors refusing new Medicare patients because of low payment rates is setting a new high."

Some background:

In 1998, Congress began calculating physician reimbursement for Medicare patients based on a complex formula called the Sustainable Growth Rate. This formula was intended to control Medicare spending. However, by 2002, Medicare costs exceeded the established goal. By 2005, expenditures ran 17 percent over the SGR target. Now the SGR dictates a 21.3 percent cut to physicians to meet budget. The public must understand that even before this cut, Medicare reimbursement barely covered the cost of delivering care.

For nearly a decade, Congress kicked the can down the road. By covering this shortfall with non-Medicare funds, Washington adroitly hid this fiscal time bomb from the American public. Each year Congress borrowed money from another bucket for a temporary "doc fix" and left the SGR on the books. This fiscal sleight of hand created the illusion of Medicare's fiscal viability.

However, each time the temporary "doc fix" ran out, the problem returned larger than before. The most recent cut of 21.3 percent took place June 1. For the third time this year, bureaucrats are scrambling to secure temporary life support.

But given recent massive federal spending, another bucket of money proves hard to find. Last week, the Senate failed to pass the temporary fix, leaving physicians in a devastating and unsustainable position.

Because the new lower rate of reimbursement is far below the cost of delivering care, physicians have not collected Medicare payments for the month of June while they waited for another temporary fix. Physicians now enter their fourth week without Medicare reimbursement, creating massive cash flow problems. This and other Medicare cuts forced one cardiology office to:

Limit clinic hours.
Cut staff by 15 percent.
Eliminate its capital budget for investment in new technologies and services.
Reduce employee benefits, including health care benefits and retirement.
Consider closing satellite offices.
Consider limiting exposure to patients on Medicare.

Given Medicare's repeated instability, America's seniors now find it increasingly difficult to locate a physician. In fact, many physicians who previously accepted Medicare patients are now choosing otherwise.

A recent study revealed that Texas physicians are dropping Medicare at an alarming rate. Before 2003, no more than three physicians left Medicare in any given year. However, Medicare lost 151 Texas physicians in 2008. Another 135 left in 2009. Fifty more docs left during the first three months of 2010, putting Medicare on track to lose another 200 Texas physicians this year.

The story goes on. Even before the recent draconian 21.3 percent cut, Medicare significantly underpaid physicians. On average, Medicare reimburses physicians only 81 percent of private insurance payment. The result? In 2008, the Mayo Clinic posted an $840 million loss caring for Medicare patients. Physicians increasingly look to cut their losses and pivot away from Medicare. This past January, Mayo closed the doors of one of its Arizona clinics to patients on Medicare as a pilot project to limit their financial risk.

Unless Washington solves this crisis, physicians must either contemplate bankruptcy or consider closing their doors to patients on Medicare.

C. L. Gray, M.D., is president of Physicians for Reform, www.PhysiciansForReform.org.

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