Fix Medicare's doctor payment system

Congress must act by year's end to prevent harm to Maryland's elderly residents

December 07, 2010|By Rawle Andrews Jr. and Gene M. Ransom III

First, the good news: Congress has voted to avert a 23 percent pay cut for Medicare doctors, which was scheduled to take effect Dec. 1.

The bad news? This fix only lasts one month. Unless Congress acts by year's end, doctors who treat seniors and the disabled will see their reimbursement rates cut by 25 percent, threatening seniors' ability to either find a doctor or keep the one they have.

This crisis has been more than a decade in the making.

Congress created a new system for paying Medicare doctors in 1997. Known as the Sustainable Growth Rate (SGR), it was designed to hold down physician costs by setting limits on spending. The amount Medicare would spend on tests and procedures, however, was underestimated — a miscalculation that forced reductions in physician fees to stay within overall spending limits.

By all accounts, the Sustainable Growth Rate is not, in fact, sustainable. But instead of enacting real reform of the payment system, Congress has opted for a series of short-term, Band-Aid measures, much like the one just passed. The long parade of quick fixes has undermined the confidence of physicians in Medicare and has made the payment problem ever more costly to solve.

Now, with doctors increasingly wary of seeing Medicare patients, the impending pay cut threatens the health security of the 39 million Americans who depend on Medicare.

The stakes are considerable in Maryland. Absent congressional action, Maryland stands to lose $340 million for the care of elderly and disabled patients during 2011, according to the American Medical Association. As well, more than 63,000 employees of medical practices and 775,000 Medicare patients in Maryland would be helped by congressional action aimed at stopping the cuts.

Finding a doctor in Maryland can be a challenge regardless of your age. A 2008 study conducted for the Maryland Hospital Association and MedChi found that overall, Maryland is 16 percent below the national average for the number of physicians in clinical practice.

This situation is only exacerbated for Medicare beneficiaries, whose doctors might not be paid what it actually costs to care for them. And with the first baby boomers enrolling in Medicare next year, it's more urgent than ever for Congress to take action to keep doctors in Medicare.

For seniors, this is an integrity issue. Medicare is a right they have earned by working hard and paying into the system. Access to their doctors is a key part of their Medicare benefits, and they expect to be able to keep doctors with whom they have long-standing relationships. The bottom line is this: Patients believe they are most likely to receive quality health care when they can see the doctors they know and trust.

Older Americans wholeheartedly believe this is one issue that should transcend the partisan divide. A recent AARP survey shows that older Americans of both political parties see the establishment of a stable Medicare payment system as an important priority. A full 81 percent are concerned that a Medicare pay cut could block their access to doctors. So for them, Congress must take action now.

Stopping the cut for one year should give the new Congress ample time to put aside past differences and find a permanent solution. On an issue so critical to today's seniors and future generations, inaction is simply not an option.

Rawle Andrews Jr. is senior state director for AARP Maryland. Gene M. Ransom III is chief executive officer of MedChi, the Maryland State Medical Society.

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