Medicare cuts: Doctors to get 10% less unless Congress acts

By MELINDA MAWDSLEY
http://www.gjsentinel.com

Access to physician care already is difficult for Medicare patients in the Grand Valley, but it could get tougher.

Physicians are facing a 10.6 percent cut in Medicare reimbursement this month unless Congress intervenes.

“People need to put heat on the politicians to fix the bloody system,� said Dr. Mike Pramenko, a family physician with Primary Care Partners.

Dr. Joel Schaefer, a general and trauma surgeon with General Surgeons of Western Colorado, said emergency care would not be denied to area Medicare patients. He cautioned, however, that local physicians will consider refusing basic private care to Medicare patients because it costs more than the federal government’s Medicare reimbursement to physicians.

“The amount of money Medicare pays us to take care of people has nothing to do with how much it costs to take care of people,� Schaefer said. “It is entirely based on how much money is in the system.�

The U.S. Senate has until July 15 to come up with a compromise on what to do with Medicare reimbursement for health care professionals, or the 10.6 percent cut will take effect.

A bill to increase Medicare reimbursement by 1.1 percent passed in the U.S. House on June 24, but it was filibustered in the Senate on June 26.

Sen. Ken Salazar, D-Colorado, voted for it. Sen. Wayne Allard, R-Colorado, voted against it. President Bush has said he would have vetoed the bill.

Congress reconvenes Monday and is expected to resume Medicare discussions with the July 15 deadline in mind.

The Department of Health and Human Services Secretary Michael Leavitt has agreed to hold Medicare claims through July 15 to allow the Senate to reach a decision, according to Allard’s office.

Medicare reimbursement rates have been an issue for nearly a decade, Pramenko said.

Congress consistently steps in and approves a minimal reimbursement increase such as the 1.1 percent that was proposed in the bill that failed last month, he said.

“Even with the ‘fixes,’ the physician-payment rate is flat and comes nowhere near covering our escalating costs, cost of living and inflation,� Schaefer said. “When overhead far outpaces payment, it is effectively a payment cut every year.�

“If a blood vessel bursts, you don’t continue to give blood transfusions, you get the foundation fixed,� Schaefer said.

Physicians are reimbursed about 20 percent less than it actually costs them to see a Medicare patient when cost of running a clinic, paying staff, etc. are factored, according to the American Medical Association.

Schaefer has an annual $40,000 premium for malpractice insurance. Pramenko’s malpractice insurance premium is approximately $10,000 a year. Neither physician is considering changing his profession, but they agreed that fewer and fewer aspiring physicians are going into family practice or are becoming internists or general surgeons because of the low Medicare reimbursement rate.

The number of people on Medicare is expected to increase as the baby boomer generation ages.

In a 2007 American Medical Association online survey of nearly 9,000 physicians across the country, 60 percent said they “plan to limit the number of new Medicare patients they treat� if Medicare payments are cut by 10.6 percent this month.

Schaefer did not want people to panic. “We are in better shape than most of the country,� when it comes to Medicare patients being able to see physicians.

However, “If you keep cutting doctors off, who’s going to see the patients?� Schaefer asked.

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