May 6, 2010 -
Call it Medicare's version of Groundhog Day. For the third time this
year, Congress has just days to avert a scheduled 21 percent cut in pay
to doctors who treat seniors and others on the Medicare program. And
while just about everyone agrees a cut of that magnitude would be
devastating for Medicare and the patients it serves, no one seems to be
able to figure out how to solve the problem in anything except a stopgap
way.
The trouble
actually dates back to 1997, when Congress passed a balanced budget law
that put the current formula in place determining how doctors will be
paid. The idea was that if doctors as a group cost Medicare too much,
their pay would be docked to make up the difference in future years.
But James
Rohack, president of the American Medical Association, says it was clear
from the start that the "sustainable growth rate" would be anything but.
"We want to
keep people healthy, and this formula penalizes [doctors] for doing the
quality care you want," Rohack says.
For example,
he says, "by keeping people's blood sugars under control, or helping
them stay out of the hospital when they have heart failure," doctors may
save Medicare money overall, but run up overall physician spending that
then triggers future physician pay cuts.
Finding
Physicians Who Take Medicare
And if those
cuts get big enough, people worry that over time there will be more
patients like Janice Jessup, a Medicare beneficiary in Virginia Beach,
Va.
The last time
Jessup needed to find a new primary care doctor a couple of years ago,
she says she called as many as 40 doctors all over town. And what did
they tell her?
"They weren't
taking Medicare patients anymore," she says.
Jessup, who
had severely cut her leg and ended up needing substantial follow-up
care, eventually went to a walk-in clinic where she did get the care she
needed. But it wasn't the care she wanted.
"It isn't the
full medical attention you need with a primary physician. No lab tests
or anything," she says.
'Chaos' For Doctors
From the doctors' point of view, however, it's not hard to see why
they're getting more reluctant to take on new Medicare patients.
"We haven't had a raise in seven years," says Joseph Stubbs, the
immediate past president of the American College of Physicians, which
represents more than 100,000 internists.
Stubbs says as professionals, doctors feel a strong sense of duty to
continue to care for their Medicare patients, even when profits erode.
But at some point the balance will tip, he says, including for his own
group of nine doctors in Georgia.
"We're having to face, well, if those cuts go into effect, we need to
cut personnel," he says. "It will cost us, instead of reimburse us, to
take care of Medicare beneficiaries."
And Congress has now made matters even worse, Stubbs says, by delaying
the cuts not a year at a time, but because of complicated federal
budget rules only by a month or two.
That's because making the cuts disappear entirely would add to the
federal deficit at eye-popping amounts. An estimate issued last week by
the Congressional Budget Office said merely canceling projected cuts in
Medicare pay for doctors over the next decade without giving them any
increases could cost $276 billion over the next decade.
But the short-term fixes have left physicians wondering what their
income might be, and what to tell patients.
"It is absolute chaos for us as business people," Stubbs says. "What
business could deal with not knowing whether your price is going to be
up in the next month, or the same, or be cut by 21 percent? It's no way
to be able to plan."
Searching For A New System Isn't Easy
Groups representing patients want to ensure that there are enough
doctors to serve Medicare beneficiaries. But they're wary about the
doctors' prescription for fixing the problem, which calls for repealing
the current formula in its entirety.
"We don't just want to just remove all limits on what doctors can
charge. That's a good way to get to bankruptcy," says John Rother of the
senior group AARP.
Still, Rother agrees with the physician groups that Congress has not
been fair about its handling of their Medicare payments.
"No one would defend a month at a time. Even a year at a time is
problematic. So we certainly believe if it can't be permanent, it ought
to be a multiyear fix," he says.
Physicians, not surprisingly, are a bit more emphatic about what they
want from Congress, particularly after the issue got punted from the
recently enacted health overhaul bill because of its price tag.
"From a fiscal standpoint, when they say they, 'Well gee, we can't do it
because it will add to the deficit,' well, the reality is every one of
these temporary patches has grown the deficit," says Rohack. "They could
have fixed this three years ago for less than $50 billion."
Now the number is rapidly approaching $300 billion.
So the search continues for a new system that would pay doctors on
Medicare fairly, but neither too much nor too little. That search has,
so far, been elusive.
And the latest delay in the cut expires on May 31.
Bill passed with help of only three Republicans,
signed by President last night
