The impasse in Congress over extended payroll tax cuts and unemployment benefits also has stalled action on a measure that could be crucial for physicians and seniors on Medicare: the “doc fix” plan.
Action on a plan is needed before the end of the year to avert an automatic 27 percent cut in Medicare payments to physicians. If Congress doesn’t act to prevent the cut, doctors who already lose money on Medicare might leave the system, which means some of the 1.2 million Georgians on Medicare might have fewer choices in physicians.
While Congress typically averts the cut and is expected to do so again this time, the need for an annual “fix” in the payment system is already eroding Medicare’s popularity among doctors. Many practices now limit the number of Medicare patients they will see because the program doesn’t cover their costs.
Some doctors refuse to take Medicare at all, although at least one study shows the large majority of Medicare patients have no trouble finding doctors.
Sandra Hardy of south Fulton County said her longtime physician’s practice stopped accepting the plan she and her husband were on. She asked friends to recommend doctors, but several would not take her as a new patient before she eventually found one who did.
“I got to where I would call and I would say, ‘You don’t take Medicare, do you?’” said Hardy, 73.
The current system was devised as a way to control Medicare spending.
System’s formula
Each year, a formula called the “sustainable growth rate” calculates the payments the system can afford. If costs exceed the target for total spending, the system adjusts payments downward automatically. But since 2002 — when the formula started calling for significant cuts in physician rates as the volume of Medicare services climbed — Congress has ignored the formula’s requirements after doctors warned that such cuts would prompt them to stop taking Medicare.
Every time Congress averted the cuts, the cost of a long-term solution has grown by billions of dollars.
This time the House has included a two-year “doc fix” in an end-of-year bill that includes an extension of a payroll tax cut and unemployment benefits, but it is being held up in the Senate due to unrelated controversies. The temporary fix has bipartisan support; a long-term solution will be tricky.
Doctors and Washington policymakers of both parties agree that a wholesale redesign of Medicare’s dysfunctional payments system is needed. Still, Marietta Republican Rep. Phil Gingrey, co-chairman of the GOP Doctors Caucus, said it could cost $275 billion to permanently overhaul the payments, and finding offsetting savings will be a challenge.
Dr. Florence C. Barnett, a neurosurgeon who practices in Johns Creek, said she recently made the difficult decision to get out of Medicare. She said the plan covered just a third of what it cost her to see patients — and she found herself facing a growing Medicare patient population after other Atlanta neurosurgeons left Medicare last year.
“This is the way the government will ration health care,” Barnett said. “The people who can afford it will have health care, and the people who are only on government support — they will not be able to find a doctor or they will have a very long wait. It’s happening now.”
Barnett said she wants to be able to privately contract with her patients and get rid of government controls on how she bills patients.
Dr. James Sams, medical director of the Piedmont Physicians Group, said a new approach needs to abandon the current fee-for-service system that rewards volume and replace it with a payment system that rewards doctors for keeping patients well. Sams, whose own primary care practice no longer takes new Medicare patients, said the nation has a moral imperative to come up with a solution.
“All the market drivers and things coming to a head right now can take us there if we are creative and willing to embrace enough change to get there,” Sams said. “The docs say just pay us more to see them. That’s not the fix. Enhancing fee for service will just make us bankrupt quicker.”
It’s unclear how widespread the access problem is today.
Limiting Medicare
A survey by the Medicare Payment Advisory Commission found that among patients looking for a new primary care doctor in 2010, 79 percent said they had no problems finding one. But according to the American Medical Association, which represents doctors and has historically resisted limits in reimbursements, nearly a third of primary care physicians already limit the number of Medicare patients in their practices. The AMA website advises doctors on how to decide whether to leave Medicare, even offering sample form letters to patients.
Practices that are part of the Piedmont Physicians Group all see Medicare patients, but most no longer accept new ones, Sams said. At the WellStar Health System, all but one of the primary care practices see Medicare patients, though some don’t take new ones. All WellStar Medical Group specialists see and accept new Medicare patients, the system said.
The practices that limit Medicare do so because they have to maintain a mix of patients to stay stable financially, WellStar said. In fiscal 2011, WellStar’s physician practices, hospitals and other facilities were reimbursed $45 million less than the cost of care provided to the Medicare patients seen by the system.
Dr. Sandra B. Reed, president of the Medical Association of Georgia, said leaving Medicare is an extremely difficult decision for physicians.
“These are our senior citizens and our most vulnerable population,” said Reed, an OB-GYN from Thomasville. “These patients need a good medical home, and they have worked all their life and paid into the system. And the system is not able to give them what they are promised.”
Hardy, the south Fulton resident on Medicare, eventually found a practice in Newnan that takes new Medicare patients. She is happy with her doctor, but not with the way lawmakers in Washington are handling Medicare.
“I would love to be in the Senate,” she said. “I would have my insurance paid for the rest of my life ... I don’t feel like they are taking our interests at heart. It’s going to get worse. I promise.”
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