Docs turn to Congress to stop Medicare cuts

By Alison Snyder
http://www.libn.com

Physician groups are aggressively lobbying Congress to stop a controversial 10 percent cut in Medicare reimbursements, which doctors on Long Island argue would force some to stop taking the government-sponsored health plan.

The proposed 2008 cuts were announced in November by the Centers for Medicare and Medicaid Services.

Doctors immediately called the cuts unacceptable and are hoping that a fix, albeit temporary, could keep the lower payments from ever being implemented. Congress has intervened six years in a row to stop the planned cuts from taking place.

Last year, Congress did not intervene until late January, after the 5 percent cut had gone into effect, said Martin Greenfield, an endocrinologist based in Lake Success and president of the Nassau County Medical Society.

Kevin Dahill, president of the Nassau-Suffolk Hospital Council, predicted the rate drop would be waived, “assuming there’s no political appetite to go into an election year having cut all physicians in the country by 10 percent.�

And Jioni Palmer, press secretary for the House Committee on Ways and Means, said Congress is working on legislation that would alleviate the 2008 increase.

But time is running out and Long Island doctors aren’t sure if they will be able to pay the bills in a region known for its high cost of living.

Mark Cappola, executive director for the Nassau County Medical Society, said worried physicians are already eyeing cutbacks and considering moves to less-costly regions.

Combine that with rising operating costs and a 14 percent increase in malpractice insurance, and physicians are feeling the squeeze, Greenfield said.

He added that doctors might increase patient volume, thus rolling back how much time it spent with each patient, in order to make up the difference.

Patients will suffer “because they’re not going to get the time or care they need,� he said.

And since physicians are paid by the number of procedures and tests conducted, the cuts will have the greatest effect on general practitioners and internists who don’t do many procedures and have a large Medicare patient base.

“Unfortunately, in medicine, there’s no way we can turn around and pass on these costs to consumers, like in business, because Medicare and insurance companies fix our costs,� Greenfield said.

Even worse than costs, some patients might find access to health care limiting.

Dahill said physicians could choose not to accept Medicare.

“The problem is this is not a one-year problem,� Dahill said. “It will just continue to compound. The question becomes whether Congress has the fortitude to do a real, permanent fix, and there I have a lot less confidence.�

National organizations like the American College of Physicians are also urging Congress to pass a long-term fix. Like Dahill, however, they weren’t holding their breath.

Dahill said that in hospitals, physicians may also choose not to accept Medicare, causing access problems – after all, physicians admit patients for care, not hospitals. Physicians who have administrative duties in addition to treating patients and in-house physicians with contracts with the hospitals may look to them to try and make up for lost reimbursements, he said.

In 1997 a “sustainable growth rate� formula was created for Medicare, tying physician payments to the growth of the economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments.
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