Medicare Cuts Could Leave Many Without Care

Saturday, July 05, 2008
Medicare cuts could also affect patients
Some experts say the reduction in reimbursements to doctors could leave many without care.

By LORETTA SWORD
THE PUEBLO CHIEFTAIN

July 05, 2008 12:36 am
Physicians won't be the only losers if Congress fails to repeal a 10.5 percent cut in Medicare-reimbursement rates that went into effect on Tuesday.

Dr. Julie Newburg, an ear, nose and throat surgeon and president-elect of the Pueblo County Medical Society, said the cuts could have a domino effect that would leave many patients without a doctor and force privately insured patients to pay more for their care.

(Raphael Francisco, president of the medical society, is on vacation and was not available for comment.)

Newburg said many local doctors already have closed their practices to Medicare patients "because of the low reimbursements and the heavy caseload" in Southern Colorado, and especially in Pueblo.

If the latest Medicare cuts aren't reversed, she said, more primary care doctors will get out of Medicare - or leave medicine altogether - and more specialists will limit or halt services for Medicare patients.

"I can tell you that there are a number of general-practice and family physicians who have left the community recently, so a number of (Medicare) patients are already looking for a new doctor" and having difficulty finding one who will accept new Medicare patients, she said.

"It will get worse because we have a high number of indigent patients and people on Medicaid and Medicare. Another problem is that Blue Cross-Blue Shield and other large insurers will base their future reimbursement rates on the (lower) Medicare rates, so it really snowballs into a bad situation, especially for Pueblo. "It will affect the specialty practices as well. There are a number of specialists who won't take Medicare, so many of our elderly won't be served. And many of our specialists see patients from Pueblo to the Kansas and New Mexico borders, so it will affect those patients as well."

Becky Pearson, executive director of the local medical society, said the cuts will "be disastrous" for Pueblo doctors and patients.

"I have numerous people call me throughout the day every day looking for a new doctor and if they're on Medicare, it's extremely difficult to get them in with someone," she said.

"We've already lost a number of family doctors because of the Medicare situation here, and now more of them are backing away from Medicare," Pearson said.

Edie Sonn, executive director of the Colorado Medical Society, said Medicare reimbursement rates have been cut in recent years to the point that doctors now are earning less from the federal system than they did in 2001.

Members of the U.S. House of Representatives last week voted overwhelmingly against the cuts and recommended small increases instead, Sonn said, but that measure failed in the Senate and was not popular at the administrative level, either.

"Legislators on both sides of the aisle said doctors have been taking it on the chin for years now and we need to stop cutting payments to physicians and increase them instead. The way they were going to increase the payments was by slowing the rate of growth in payments to Medicare HMOs," Sonn said.

"Members of the House voted overwhelmingly last week to pass a bill that would suspend the pay cuts and replace them with a 1.1 percent increase. But it failed narrowly in the Senate because of some Republican representatives who sided with the insurance companies rather than their constituents."

Although the federal Department of Health and Human Services announced Monday that no Medicare claims will be processed until July 10, Sonn said many physicians have expressed doubt that the cuts will be rescinded when Congress reconvenes next week.

"It will be devastating to family physicians in particular. For primary care physicians, Medicare is at best a break-even proposition, and depending on their patient mix, it's a loss. When doctors can't afford to take this hit, they are faced with a choice: Stop taking new (Medicare) patients or stop treating Medicare patients entirely," Sonn said.

She cited a recent American Medical Society survey of doctors in which 60 percent of respondents nationwide said they would limit new Medicare patients and 14 percent said they'd stop practicing altogether under the new reimbursement rates because the bulk of their patients are covered by Medicare.

"Medicare patients already report trouble finding doctors who will take their insurance, so they put off their care and go to the hospital or emergency room. This idea is disastrous for doctors and patients alike, and it's going to ripple out and affect specialists and hospitals and the rest of the industry," Sonn said.