Uncertain Medicare Payment Situation Continues to Agitate Doctors

Uncertain Medicare Payment Situation Continues to Agitate Doctors; By Emily Ethridge, CQ Staff

As the Senate this week considers a proposal to reverse a 21 percent payment cut to Medicare providers that took effect June 1, physician groups say their members are increasingly frustrated that Congress has not passed a long-term solution to the recurring issue.

This is the third time this year that payment cuts have gone into effect before Congress has reversed them. Organizations representing doctors say some of their members are already refusing to see additional Medicare patients and more are threatening to leave the program altogether if the cuts are not quickly addressed.

“I have not heard this level of frustration from physicians before,” said Lori Heim, president of the American Academy of Family Physicians. “Our members are saying staying at the table to be part of the process doesn’t seem to be worth it.”

The Senate is expected to make changes this week to a House-passed package that would extend expired tax breaks and social spending (HR 4213), including a provision to roll back the cuts and provide slight increases in Medicare payments to physicians through December 2011. That is whittled down from a five-year, $88.5 billion plan to pay doctors, and nowhere near a permanent solution to the recurring issue.

But doctors say they feel betrayed by Democratic leaders who had promised to find a permanent solution to the Medicare payment formula if physicians lent their support to the health care overhaul effort (PL 111-148, PL 111-152). The House passed a bill (HR 3961) in November that would end the need for an annual adjustment by eliminating the payment formula altogether, but the Senate refused to take up a similar measure, citing concerns about deficit spending.

If doctors were to drop out of the Medicare program in significant numbers, physician groups say it would not only potentially limit seniors’ access to health care, but also undermine the health care overhaul law, which counts on Medicare physicians to test new ways to deliver and pay for care.

“Congress cannot expect physicians to adopt health information technology, engage in quality-improvement and care-coordination initiatives with payments far below the cost of providing medical care,” said American Medical Association President J. James Rohack.

Health care experts, however, discount the likelihood of doctors shunning the program, noting that 97 percent of physicians currently accept Medicare patients.

“The reality is that many physicians wouldn’t have enough patients if they stopped taking Medicare patients overall,” said Paul Ginsberg, president of the Center for Studying Health System Change, a nonpartisan research group.
Ginsberg acknowledged that with the multiple short-term patches, Congress is frustrating doctors unnecessarily, especially since lawmakers have so far blocked any of the cuts from taking effect. “We are getting much angrier physicians than we should, given what we’re ultimately going to pay them,” he said.

As evidence of that anger, AMA officials cite a recent online survey of 9,000 physicians that found that 17 percent of providers are already restricting the number of Medicare patients they see because of low payment rates and uncertainty over the cut. If Congress allows the 21 percent cut to stay in place for “four to seven months,” 50 percent of providers said they would stop taking new Medicare patients, according to the survey.

Shawn Martin, director of government relations at the American Osteopathic Association, said that one in three of his group’s members say they will stop accepting new Medicare patients if the 21 percent cut remains in place, and one in four say they will leave the program — hurting the implementation of the new health care overhaul law.

“Congress has invested heavily in electronic health records, electronic prescribing, quality improvement,” as part of the overhaul, said Martin. “The common thread that combines the physicians to all these new programs is Medicare. If providers leave Medicare, you’re really just undermining three to four years of policy put in place.”

Physician Access Concerns

Centers for Medicare and Medicaid Services (CMS) spokesman Peter Ashkenaz said the number of physicians accepting Medicare is up slightly this year, to 97.1 percent from last year’s 96 percent.

“But we are concerned that if there is not greater predictability in payments, beneficiaries could experience disruption,” he said. “That’s why the president and CMS are working with Congress to develop a permanent fix in Medicare’s payment system for physicians.”  The Medicare Payment Advisory Commission said in its annual report in March that beneficiaries’ physician access was “good and better than that reported by privately insured patients age 50 to 64.”

Gail Wilensky, a former Medicare and Medicaid administrator under President George Bush, said she sees little likelihood that doctors will prevail with efforts to get a permanent solution to the Medicare payment formula.  “The doctors kind of used their opportunity up when they supported health care reform and received nothing in return,” she said.

Wilensky, now a senior fellow at the health care foundation Project HOPE, suggested that lawmakers gain more leverage over physicians with short-term payment fixes. “When Congress decides on . . . some specifics of the next generation of a payment system, they want to be able to buy the acceptance of the physician community,” she said. “They need to keep it in their back pocket.”