Help Medicare patients get care

Cory D. Carroll, M.D.

“It saddens me to inform you that I will no longer be participating with your insurance – the government programs of Medicare (most Americans over 65) and Tricare (for certain veterans and families).

“Over the last decade, the Medicare reimbursement has grown a total of 9.1 percent (less than 1 percent per year) while my operating expenses have increased close to 50 percent (5 percent per year). The reimbursement failed to match inflation, and in 2005, the average practice revenue for primary-care doctors plummeted 21 percent, according to a Medical Economics survey.

“On July 1, the Centers for Medicare Services enacted a 10.6 percent cut to my services for your care. This is the straw that broke the doctor’s back.

“It saddens me to take this step, but I have no other choice. …”

The above letter is being considered by many physician offices (nationwide). The average family physician/internist will be the hardest hit; they are being forced out of private practice. However, similar to prior years, Congress can act to “reappropriate” funds and stop the draconian cut.

The escalating costs of the Medicare system cannot be ignored, but physicians (especially primary-care docs) are a relatively small portion of the whole medical system’s expense. Also, there is good evidence that effective primary care will save Medicare money in the long run.

Obviously, the cut came about because the government is not able to pay for all the services that Medicare provides. Simplified, Medicare is divided into four parts; A, B, C and D. Part A covers hospital care, Part B pays for outpatient services (doctors and others), Part C is the privatization plan (Medicare Advantage) combining A and B, and Part D is the prescription drug benefit.

The pay cut listed above only affects Medicare Part B – the providers of care. There is money available to offset the cuts, but changes need to be made whole system.

Why is it that the pharmaceutical industry is not facing any cut regarding Medicare D – despite record profits? (Hint – Medicare D legislation was written by the pharmaceutical industry.) Public funds are buying most of the Medicare recipient’s drugs at ridiculously high prices, and there is absolutely no cost containment with that system (as opposed to Part A and B, where the government sets the fees).

Medicare Advantage, or Part C, has the private insurance administering parts A and B (similar to HMOs and PPOs). This privatization of Medicare is touted as a more cost-effective system, but studies show that patients insured by Medicare Advantage are no better off than those under plain Medicare. President Bush has threatened to veto any bill that will cut the insurance companies’ profits yet stands by while the some of the primary-care docs go bankrupt.

House Resolution 6331 is a bill in Congress that will stop the cut. This bill passed the House and is stalled in the Senate. Please call Sen. Wayne Allard at (202) 224-5941 and tell him to support HR 6331 (Sen. Ken Salazar is supporting this bill). Also, a call to President Bush at (202) 456-1111 for support rather than a veto on this bill if it passes Congress would be a good idea.

Hopefully, if Washington implements HR 6331, doctors will not have to write the above letter to our Medicare and Tricare patients.

Cory D. Carroll, M.D., is a board-certified family physician from in Fort Collins.

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