Local surgeon would like to see Medicare system cured

by Ruth Campbell

A Midland vascular surgeon wants to see a crisis in Medicare — not to hurt patients, but to provoke a change in a “broken” system of care coverage. His comments follow a complex procedure in the U.S. Congress that would cut Medicare reimbursements to physicians by 10.6 percent.

“My feeling is that the Medicare program is broken in a multitude of ways and if it’s going to take a crisis to get our senators and government to finally fix the program, then we should do what we can to give them their crisis,” vascular surgeon Dr. Russell Sawyer said.

The cut was scheduled to take effect July 1, but the Centers for Medicare and Medicaid Services said Monday it will hold doctors’ claims for the first 15 business days of July, giving Congress more time to work out a reimbursement agreement, according to U.S. Sen. John Cornyn’s office.

U.S. Rep. Mike Conaway, R-Midland, said he is “confident” Congress will reverse the pending cuts, but warns a crisis is looming in 2011 when more baby boomers become eligible for Medicare.

Sawyer, of Midland Surgical Associates, said 45 percent of the practice is made up of Medicare patients. He said an additional 5.6 percent cut is proposed for January 2009, which would bring the reduction in reimbursements to 15-16 percent.

“If you think about a 10 percent cut in Medicare reimbursement now; that equals a 19-22 percent cut over the last 14 years,” Sawyer said. “Is there anyone around who would except being paid 20 percent less now than they were being paid in 1994? I think most people’s response would be no way. Should physicians be any different?”

He said the reimbursement reduction won’t affect patients as long as there are physicians willing to provide care to Medicare patients. But if doctors decide they’re not willing to endure another pay cut, they could declare themselves non-providers.

“Then what will happen is getting access to a Medicare-providing physician will be more difficult. I don’t think there are any physicians … in this country would refuse care in an emergency. I would never do that, nor would any of my associates. However, it may come to the point where you have to refuse to offer elective services as a non-provider because the amount Medicare is willing to pay and the amount it costs to run a practice can’t come close to coinciding,” Sawyer said.

Contrary to Sawyer, family physician Dr. Peter Valenzuela at Texas Tech University Health Sciences Center hopes the problem will be resolved so he can keep being reimbursed at the current rate.

Formerly in practice in Fort Stockton, Valenzuela said the proposed cut will be worse for physicians in rural areas where they are needed most.

Some 25 percent of Valenzuela’s patients are on Medicare and 30 percent commute to his office in Odessa from Fort Stockton. If he bills $100, he gets $25 of that — not enough to cover expenses.

“The impact is going to be enormous. Texas has 2.5 million people on Medicare and all of a sudden they’re going to cut the rates they’re paying doctors for it,” Valenzuela said. “I’m hoping Congress will reverse this and make some amendments at the last moment before (the cuts) are implemented.”

Both Cornyn and Conaway said they tried passing measures that would have avoided the cuts. Conaway said it’s “standard operating procedure” for lawmakers to get to the “brink of disaster” before doing anything.

Cornyn and U.S. Sen. Kay Bailey Hutchison, both R-Texas, voted against a bill proposed by U.S. Sen. Max Baucus that would have been vetoed by President Bush and started the process all over again. A Cornyn spokesman said the Senator voted for a 30-day extension earlier this week, which was blocked by Democrats.

Reacting to his vote, the Texas Medical Association Political Action Committee (TEXPAC) withdrew its support for his Senate re-election.

Cornyn introduced the Ensuring the Future Physician Workforce Act of 2008 earlier this year to repeal the sustainable growth rate (SGR) enacted as part of the 1997 balanced budget amendment, a spokesman said.

Sawyer said every year more people are eligible for Medicare and yet there is only set amount of money for the program, resulting in fewer dollars spent on each patient.

He also would advocate cost sharing for Medicare. If you are at a certain income level, you would pay nothing for treatment and if you made above a certain amount, you would pay something. Sawyer said this would be similar to means testing.

Sawyer also advocates getting rid of managed Medicare plans where patients are shifted to private insurance companies. The cost of taking care of these patients is higher because you have to have prior authorization to perform procedures such as X-rays or lab tests.

This requires a lot of paperwork, which physicians have to pay their staff to do.

“Then you run into the problem of insurance either refusing (to pay) or making access difficult for these kinds of things,” Sawyer said. The managed Medicare plans also take longer to pay reimbursements and “there are a lot more mistakes in your reimbursement.”

Reimbursement for various procedures also has to be revised because there are certain things Medicare won’t pay for. This means doctors must place patients in the hospital, which costs more.

Midland Memorial Hospital Chief Financial Officer Larry Sanz said the Medicare situation does not have much impact on the hospital because hospitals are reimbursed differently than doctors. Fifty percent of the hospital’s patients are covered by Medicare.

Sanz said he thinks a resolution will be found.

“They haven’t let cuts stand in the past so I think they’ll do something, especially in an election year,” Sanz said. Hospitals have seen cuts in skilled nursing and rehabilitation services, but he said at least facilities receive cost of living increases every year in their reimbursements.

Ruth Campbell can be reached at ruth@mrt.com.

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