Medicare reimbursement cuts concern local doctors


SEVIERVILLE – Linda Carter gets emotional when she talks about how proposed cuts in the payments doctors get from Medicare might affect her husband Rodney’s medical practice and, perhaps more importantly, how it might affect those patients who need care most.

“A lot of us (medical practices) are financially struggling right now and you just wonder how much farther you can go,” says Carter, who manages the office at LeConte Family Practice. “This is one of the first times they voted to cut the payments we get. They know that the outcome most likely will be a flood of doctors opting out of Medicare.”

That flood may include LeConte Family Practice, one of the last local doctors’ offices still accepting new Medicare patients, though Carter says she hopes it won’t come to that. With physicians actually losing a considerable amount of money for each Medicare patient they treat now, she says the loss could be devastating for small, independent practices like LeConte.
Not only that, Carter warns the move may mean doctors are inclined to devote less time and attention to Medicare patients, meaning their care may suffer.

Congress recently voted to approve a financial bill that would cut the payments doctors receive by 10.6 percent, with the possibility for a subsequent decrease at the beginning of 2009. Carter points out it’s not the first time federal leaders have attempted to cut the funds doctors get from Medicare, but says those proposed decreases are usually reversed.

“Almost every year there’s a bill that comes before Congress that proposes some cut for the payments doctors get and they come up because the Medicare billing process is flawed and they know that,” Carter said. “Usually they pass the funding bills without the cut, but this year it’s getting pretty scary that they might actually go through with it.”

Though the cut was set to take effect Tuesday, government officials announced Monday claims for payment from doctors will not be processed until July 15 to give Congress more time to consider a bill that would reverse the move. That legislation (HR 6331) failed in the Senate by a single vote last week before Congress went on its break for the July 4 holiday and is set to come back before federal legislators next week.

Among those voting against the bill are Tennessee’s two Republican senators, Sen. Lamar Alexander and Sen. Bob Corker. Opposition to the action fell mainly on party lines, with Republicans voting overwhelmingly to reject the move that would pay for an increase in the payments doctors receive by cutting costs in the Medicare Advantage program, which gets private insurance companies to provide benefits for senior citizens in place of the government.

Doctors’ organizations like the American Medical Association (AMA) are taking aim at Alexander and Corker, along with others who voted against the action, in an advertising campaign. Democrats also see the opposing party’s rejection of the bill as a potential campaign issue in an election year when most voters rank health care among their top three concerns.
Though calls to Alexander’s office for comment were not returned Wednesday, Corker Press Secretary Laura Lefler defended her boss’ vote and accused the AMA of doing “a tremendous disservice for physicians in Tennessee.”

“Sen. Corker is strongly supportive of ensuring that physicians do not take a cut,” Lefler said. “His procedural vote last week was because the bill is not as good for Tennessee doctors and hospitals as it should be and he knew the administration would delay the Medicare reimbursement cuts until July 15, which will hopefully allow us time to reach a bipartisan compromise that delays the Medicare physician payment cuts and that is good for Tennessee and good for the country.”

Lefler says putting the bill’s future in jeopardy forced lawmakers back to the table, where Corker plans to demand reimbursements offered to the Regional Medical Center at Memphis for treating Medicaid and uninsured patients from other states be reinstated. Further, she maintains doctors would actually thank Corker for his vote if they understood his reasoning.

Even if one or both of Tennessee’s senators switched their votes on the bill and it passed, President Bush has promised to veto the move, and finding the votes to overturn that veto would likely be a challenge.

Carter remains hopeful a compromise will be reached that won’t cost offices like LeConte tens and even hundreds of thousands of dollars a year. She and other staffers at the office are passing out fliers encouraging patients to contact Alexander and Corker to express support for the bill reversing the cut.

Still, with supporters struggling to break the Republican opposition to the bill and the president’s veto pen at the ready if it does, she realizes she and her husband may face some tough decisions in the coming months.

“We don’t want to leave our patients without care, but we just can’t keep doing this,” she says, her voice cracking with emotion. “Doctoring is something you choose to do because you want to help patients; you’re committed to that. But when you struggle so hard, you wonder if you should continue doing it. We’re still trying to keep the dream and do a good job with the way we treat our patients. It’s still worth it to fight to the end to keep doing what you love to do.”

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