Local physicians fear cost of cuts to Medicare reimbursements

BY PAT FERRIER
http://www.coloradoan.com

Local doctors who treat Medicare patients have found themselves in the middle of a federal fight that could strain their budgets and make it more difficult to treat older patients.

At issue is a two-week delay in Medicare payments ordered by the Bush Administration that went into effect Tuesday. During the delay, doctors will see a gap in reimbursement payments for patients on Medicare, the federal insurance program for people aged 65 and older.

Ultimately, the dispute could lead to a crisis for physicians who can’t withstand the financial hit from their Medicare patients, said Dr. Cory Carroll, a solo practitioner in Fort Collins.

Medicare issues checks every day giving doctors a steady flow of income, Carroll said.

“Now I’m being told I won’t get a dime in 10 days,” he said. “But rent’s due; paychecks are due.”

The Bush Administra-tion ordered the delay so the Senate could consider reversing a scheduled 10.6-percent cut in Medicare reimbursements.

The House voted to halt the 10.6-percent cut.

Only Congress can block the cut to doctors’ payments. The proposed legislation, which passed the House 355-59 and fell one vote short in the Senate, has broad support from doctors, hospitals and pharmacists but is strongly opposed by the insurance industry.

The Bush order means Medicare claims that would have been paid in mid-July probably will be delayed up to a week, the agency said.

Congress, facing the prospect of millions of angry seniors at the polls in November, will be under pressure when it returns to Washington Monday to act quickly to prevent the cuts in payments for some 600,000 doctors who treat Medicare patients.

Senate Republicans and the White House are in a standoff with Democrats seeking to cut subsidies to insurance companies that provide Medicare coverage to “pay for” easing the payment cuts to doctors. There’s no guarantee the standoff will be broken soon.

America’s Health Insurance Plans, a trade group of private insurers, is siding with Senate Republicans and the White House in their standoff.

Ads scheduled to run on TV through the weekend say reducing payments to private insurers through a program called Medicare Advantage could push millions of seniors out of their current coverage.

Eileen Hendee, coordinator of the Aspen Club at Poudre Valley Hospital, said she hopes the dispute doesn’t trickle down to patients.

Hendee has a list of 25 doctors who are accepting new Medicare patients.

But she worries if reimbursements are reduced or there’s a long delay in getting money to doctors, more physicians will simply bump older patients out of their practices.

“With more people turning 65 every day, it could be a real problem if it comes to that,” she said.

Carroll said any delay in payment – and certainly a cut in reimbursement rates – will make it difficult for many family physicians to pay their own bills or put them out of business entirely.

Like Carroll, Linda Gillam, practice manager at Fort Collins Family Physicians, 2121 E. Harmony Road, said the three-doctor practice may have to stop treating Medicare patients, who make up between 15 and 20 percent of the practice.

It has already stopped accepting new Medicare patients.

“We’ll have to wait to see what the Senate does,” she said. “Then we will probably evaluate the financial impact on the practice and make a decision.”

The American Academy of Family Practice Management estimates a 10.6 percent cut in Medicare reimbursement translates to a 2- to 3-percent reduction for the typical family practice.

Every year, Congress steps in “at the 11th hour” to stop scheduled decreases in Medicare reimbursement, Gillam said.

This year that help, so far, has not come.

“This is a wake up call for all of us to say ‘wait a minute. This has to be fixed.’ ”

Gillam worries the Senate will allow the cut in reimbursement rates, pushing the problem to the next administration in January.

In an e-mail from Sen. Ken Salazar to Gillam, Salazar said he would “continue to fight to pass fiscally-responsible Medicare legislation that includes improvements for Ameri-ca’s seniors, families, and health care professionals.”

The impact on doctors goes beyond Medicare patients, Gillam said.

Contracts with other private health insurance companies are typically based on Medicare reimbursement rates.

“I’ll have to call them all and let them know we will not accept a pay cut,” she said. “We’re a small practice and don’t have a lot of negotiating power. It could have a huge impact on our practice.”

The American Medical Association issued a statement recently blasting Republican senators, including Colorado Sen. Wayne Allard, for voting to “protect health insurance companies at the expense of America’s seniors, disabled and military families.”

“Today … we stand at the brink of a Medicare meltdown,” AMA President Dr. Nancy H. Nielsen said. “On July 1 … the government will slash Medicare physician payments by 10.6 percent forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.”

Associated Press contributed to this report

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