Edward Langston: Medicare cuts put future of seniors' health at risk

Edward Langston, M.D.

On July 1, the government health insurance program for seniors and the disabled will automatically begin draconian payment cuts to physicians. During a year and a half, the cuts translate to a loss of $50 million to Maine physician practices caring for Medicare patients. But the real losers are Medicare patients who will be left with reduced access to physician care.

The 270,000 patients who rely on Medicare in Maine will bear the brunt of the Medicare cuts to physicians, as doctors are forced to make tough decisions because of cuts that push payments far below the increasing cost of providing care. This is not a hypothetical situation: 60 percent of physicians say this year’s cut will force them to limit the number of new Medicare patients they can treat.

Consider that the average senior sees at least seven physicians a year, and the prospect of not being able to find a new physician has a range of consequences. In three years, the first wave of baby boomers will reach Medicare age, and the Medicare rolls will keep expanding as one-fifth of the U.S. population will be over age 65 by 2030. Compound this with the fact that we’re already beginning to feel the effects of a looming physician shortage, and the future of seniors’ access to care may be dire.

Current Medicare payments to physicians are about what they were in 2001, while the costs of running a medical practice have increased. It’s no secret that costs everywhere are skyrocketing — just try filling up a tank of gas or buying a week’s worth of groceries. If the cuts go through as Medicare projects, physicians will be paid more than 15 percent less than they are paid now over a year and a half. If the cuts aren’t stopped, the bottom line is that having a Medicare insurance card will not guarantee access to physician care.

Intervention by Congress is the only way to stop the cuts, as they will occur automatically due to a flawed mathematical equation that ties payments to the ups and downs of the economy instead of the health care needs of seniors. This year’s cut of 10.6 percent begins this summer — and time is running short for action.

The silver lining in the cloud is a bipartisan commitment to preserving seniors’ access to care and legislation introduced by Sen. Debbie Stabenow and co-sponsored by Sen. Susan Collins. If enacted, the Save Medicare Act of 2008 (S 2785) would replace 18 months of Medicare physician payment cuts with payment updates that better reflect medical practice cost increases. Taking action for more than one year is critical to inject some stability into the system for seniors and their physicians.

The 18-month time frame is also desirable as it will give lawmakers time to work on creating a new payment formula for physicians — one that puts them on the same footing as hospitals and other health care providers that are paid based on the cost of providing care. Until that happens, we’re stuck in a vicious cycle of urging Congress to address the immediate crisis of looming Medicare cuts.

The alarm bells are already ringing: The Institute of Medicine just released a report on the problems of caring for a graying America and called for more training in geriatric care and higher Medicare payments to physicians. MedPAC, Congress’ advisory commission on Medicare, found that 30 percent of Medicare patients seeking a new primary care physician have trouble finding one and recommends increasing Medicare physician payments. Last but not least, the government predicts an overall shortage of 85,000 physicians by 2020, just as baby boomers flood Medicare.

There’s an implicit contract between the government and the American people that Medicare will be the health care safety net for seniors and disabled Americans. But if the government won’t pay physicians a fair rate for caring for these vulnerable patients that contract is broken. A recent public poll found that nearly three-quarters of Americans want Congress to stop the cuts, and lawmakers hear directly from concerned citizens through the American Medical Association’s Patients Action Network.

Congress must take immediate action to replace 18 months of cuts with payment updates that reflect increasing medical practice costs. This will demonstrate real leadership as we work to preserve access to care for current and future generations of Medicare patients.

Edward Langston, M.D., is chair of the board of the American Medical Association.

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