Doctors troubled by possible reduction in Medicare payments

Friday, September 28, 2007 | 10:53 a.m. CDT; updated 10:03 a.m. CDT, Friday, July 11, 2008

KANSAS CITY — Representatives of medical groups said Thursday that planned cuts in Medicare reimbursements to doctors would cause such financial hardship for physicians that it could become difficult or impossible for some people to get medical treatment.

Unless Congress intervenes, Medicare payments to physicians will be reduced 10 percent beginning Jan. 1, with the reductions increasing to 40 percent by 2016. The American Medical Association said a recent survey found that 77 percent of 8,955 physicians surveyed would limit the number of Medicare patients they treat if the 40 percent reduction occurs.

The cuts come as physicians’ costs continue to rise. Many doctors already are curtailing the number of Medicare patients they see, or quitting practice altogether, William G. Plested, the immediate past president of the AMA, said Thursday in a news conference in Kansas City.

The proposed cuts in the next two years would cost Kansas physicians $140 million for the care of nearly 380,000 Medicare patients, the AMA said, while Missouri doctors would lose $290 million for caring for the state’s 854,000 Medicare patients. If the reductions continue through 2016, Kansas would lose $2 billion and Missouri would lose $4.6 billion, the association said.

The AMA said the cuts also would hurt nearly 113,000 members of military families in Kansas and 148,000 in Missouri because their health insurance system is tied to Medicare.

The country already has a lack of primary care doctors, and the reductions will only make that worse, Plested said.

“It’s simple, it’s pure dollars and cents,” Plested said. “You cannot go into rural Kansas, open a family practice after five years of medical school, and a quarter of a million dollars in debt, open an office and see patients. You can’t do it. It doesn’t pay.”

Plested’s visit was part of a national AMA campaign to urge Americans to ask their Congressional representatives to cancel the Medicare cuts before January, and to enact a minimum increase in reimbursements to cover the rising costs of providing care.

Sen. Pat Roberts, R-Kan., said in a statement that he agrees with the AMA’s concerns.

“As a member of the Senate Finance Committee, I am committed to making sure Congress acts quickly to overturn these potentially devastating cuts to our Kansas doctors,” Roberts said. “I have long been a champion of making sure we can allow our doctors and other practitioners to continue to provide care for Medicare patients.”

Sen. Kit Bond, R-Mo., agreed, saying in a statement that the current Medicare payment formula for physicians is “unfair, unpredictable and must be reformed.”

“I have voted to stop these cuts in the past and will continue to oppose Medicare physician cuts that compromise seniors’ access to care,” Bond said.

While acknowledging that Congress usually rescinds proposed Medicare cuts before they take effect, officials at the news conference said the yearly debate masks a deeper problem of finding doctors willing to provide care for increasing numbers of uninsured or underinsured patients.

And, they said, that problem is likely to get worse if doctors reduce their Medicare patients at the same time that baby boomers start reaching 65.

Charles W. Van Way III, president of the Missouri State Medical Association who is a surgeon at Truman Medical Center in Kansas City, said the emergency room there already is closed 30 percent of the time because it cannot handle the patient load.

“The prospect of watching more patients drop out of care (and seek medical help at the emergency room) because the doc simply can’t afford to take care of them is just appalling,” Van Way said.

And Art Snow, a geriatric physician from Shawnee Mission, Kan., said doctors who primarily treat the elderly already are having trouble keeping up with increased costs.

He said the AMA survey found that if the 40 percent cut is enacted in the next nine years, 72 percent of the physicians surveyed said they would discontinue treating patients at nursing homes.

“I think this is a very ominous sign of what may be coming for those of us who care for Medicare patients and the repercussions on these patients themselves,” Snow said. “Who is going to care for them?”

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