To preserve Medicare, protect access to doctors


ONLY AFTER much turmoil on Capitol Hill and fears of disruption to the health care system that serves more than 44 million beneficiaries did the Senate and House vote to do away with the 10.6 percent cut in Medicare payments to physicians

But the successful override of President Bush’s veto on July 15 was just a reprieve, not a solution.

We got to this point by Washington relying on the 1997 Balanced Budget Act to tighten federal spending, with a key provision that automatically triggers cuts in the fees paid by Medicare to physicians – unless Congress and the president vote to reject or modify the funding formula. Today the clock is already ticking on another automatic cut – one that, in a mere 18 months, will hit physicians with a mind-boggling reduction of 21 percent.

Origins The time has come to regain some perspective about how important Medicare is to our nation, as we must restore the integrity of this health care entitlement for our seniors.

Before Medicare went into effect in 1965, only half of older adults had health insurance. Today, Medicare’s universal coverage of those over 65 ensures care for more than 1.3 million residents in New Jersey, which is 15 percent of our state’s population and growing. With over half of Medicare beneficiaries having incomes below 200 percent of the poverty level, the program is widely credited with dramatically reducing economic pressures among older adults.

The recently averted 10.6 percent cut in Medicare fees was sending the wrong message to practicing physicians, as surveys by both government and industry sources document the growing number of physicians closing their practices to new Medicare patients. The Medicare Payment Advisory Commission found that 30 percent of Medicare beneficiaries seeking a new primary care physician have trouble finding one, and the commission’s reports to Congress keep warning that Medicare pay cuts will worsen patient access problems.

With experts projecting a shortage of 85,000 physicians by 2020, the continued threat of Medicare cuts will only exacerbate this situation. Those of us devoted to recruiting and training the next generation of geriatricians are facing a particularly frustrating trend. New doctors, facing repayment of substantial loans for their medical education, turn away from a career in geriatrics as they see the declining reimbursements. As a result, there are presently only about 7,000 geriatricians practicing in the United States, and our teaching hospitals are producing one geriatrician for every nine cardiologists or orthopedic surgeons.

Self-defeating policy And the future of geriatric medicine matters. With nearly 80 percent of Medicare beneficiaries suffering from one or more chronic conditions, those who provide ongoing medical management to the elderly will be hit the hardest by cuts in reimbursement.

We need to help policymakers understand how studies have demonstrated that utilization of physician services is not the cause of the Medicare program’s financial difficulties, and cuts in physician payment rates only reduce access to care without improving Medicare’s financial sustainability.

Preserving the integrity of the Medicare entitlement speaks to our country’s values. The latest patchwork maneuver is not a solution, and certainly not an affirmation of our commitment to older Americans. Witness how as Congress rejected the latest payment cuts, Medicare was simultaneously releasing its latest 834-page proposal for changes and, ultimately, reductions in reimbursement for services vital to seniors.

Failing to adopt a new, equitable Medicare payment formula for physicians is not an option. Our country cannot and should not wait 18 days let alone 18 months to address this problem.

Thomas A. Cavalieri, an osteopath, is dean of the UMDNJ-School of Osteopathic Medicine in Stratford. He is also a geriatrician and founding director of the New Jersey Institute for Successful Aging.

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