Welch: Medicare vote sends strong message

By Louis Porter

MONTPELIER – Congress appears poised to block cuts in Medicare payments to doctors that would have had a devastating effect on some Vermont physicians and patients if they had gone into effect next month.

By an overwhelming majority the U.S. House on Tuesday passed a measure preventing the more than 10 percent reduction in federal payments, and members of the Senate had reportedly worked out a bipartisan compromise to do the same when it reaches them.

“It is important for maintaining access for patients and for doctors’ salaries,” said U.S. Rep. Peter Welch, a Vermont Democrat. “If we keep cutting the heart out of primary care we are going to make it impossible for rural practices to survive.”

The vote in the House was 355-59, with a majority of both Democratic and Republican members voting to continue the Medicare reimbursements as they now stand.

The administration of President George Bush threatened a veto of the measure, which has had trouble in the Senate in the past. Welch said he is not sure of the bills’ future, but the bipartisan support in the House sent a clear signal to the Senate and the President, he said.

“We got a solid vote here in the House,” he said. “That sends as strong a message as we can.”

Vermont doctors and advocates said the bill is a good one, but added that a long-term solution to the Medicare funding question must be found in the coming months even if the measure becomes law.

“It would have been disastrous for the patients of Vermont particularly,” said Dr. Robert Block, a Bennington orthopedic surgeon.

“Almost all of us accept Medicare and Medicaid patients,” he said. But the decline in reimbursements would in many cases have meant the difference between breaking even serving those patients and losing money.

“We would have to start limiting the number of patients we could see under those circumstances,” Block said.

For several reasons Vermont would have been hurt disproportionately if the cuts had gone into effect as planned.

For one thing, Vermont doctors traditionally charged less for the same procedures than nearly every other state. So when the Medicare fee schedule was put in place years ago it locked that difference in, so the rates Vermont doctors have received since have remained lower than in other states, Block said.

Partly to level the playing field, physicians in Vermont and other places get a differential for rural states. That differential would also have been wiped out July 1. That means the reduction in Medicare payments would have resulted in an additional 1.7 percent reduction in payments for Vermont doctors above the 10.6 percent cut across-the-board.

“For Vermont physicians the potential cut was 12.3 percent,” said Paul Harrington of the Vermont Medical Society, which has been working to stop the cuts in Medicare payments. “Once you get into double digit cuts and you are a small rural practice with a large number of elderly patients, typical for our practices, it could have a devastating impact.”

In addition, Vermont’s population is older than most states. That means a larger portion of Vermonters are eligible for Medicare and that portion likely is to grow.

“We have a bulge in the elderly population that is Medicare eligible” and a shortage of younger workers to pay the cost of coverage, Block said. “Any drop in Medicare payment affects us disproportionately.”

While he welcomes the reprieve Congress seems likely to deliver, the stop-gap measure puts off but doesn’t halt the growing underlying problem in how Medicare is paid for, Block said. Therefore, if in future years Congress can no longer prevent the reductions, they will be that much more severe, he said.

Doctors already are feeling the pinch and having an increasingly difficult time justifying seeing a large number of Medicare patients in their practices, Block said.

For instance, a decade ago Medicare paid about $2,400 when one of his patients needed a full hip replacement. Now that payment is about $1,200, Block said. Meanwhile, the cost of everything from malpractice insurance to office space has increased.

“At a certain point, it just doesn’t pay to do those procedures,” he said.

The money for continuing Medicare payments at the current level was found, in part, by trimming the “Medicare Advantage” — a private insurance portion of the program. That on its own is a good move, Welch said.

“They were getting a sweetheart deal,” Welch said of that program. “There is no indication it increases access, it just increases costs.”

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