Low reimbursement threat: Senate must act now to keep Medicare healthy

It is up to the Senate to decide if physicians will be paid enough to ensure Medicare access for all seniors.

Editorial. Sept. 9, 2002.

Nov. 1 could be a day of reckoning for Medicare. That is the day the government unveils the final physician payment rates for 2003. Whether physicians decide on that day to leave the program in droves depends mostly on Congress.

The AMA has been relentlessly warning lawmakers about the potential consequences of inaction on the Medicare physician payment crisis. Now a new member survey drives home the point. It shows that if the government follows up this year's 5.4% Medicare physician payment cut with a hefty reduction next year, today's patient access problem could escalate into tomorrow's access emergency. Two out of five physicians, or 42%, would no longer sign the participation agreements that prevent them from billing patients more than the Medicare allowance.

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Already nearly a quarter of doctors have decreased or restricted the number or type of Medicare patients they treat, or plan to do so.

The AMA hasn't been alone in sounding the warning. Surveys by the American Academy of Family Physicians, Medicare Rights Center and Center for Studying Health System Change confirm that many physicians no longer accept new Medicare patients.

If physicians are making these hard choices now, it's not difficult to imagine what would happen if the payment cuts predicted for coming years actually occur. If current estimates hold, physicians would see their payments from the program slashed nearly 23% between this year and 2005 (if compounding is factored in).

Cuts of this magnitude would only spur more physicians to stop accepting Medicare patients. It can be an agonizing decision. Physicians don't want to end their relationships with Medicare patients, but economic realities might force them to do so.

This troubling forecast, however, need not become a reality. The U.S. House of Representatives saw the warning signs and did the right thing. In June, House lawmakers passed AMA-backed legislation that would increase physician pay by about 2% each year for the next three years. The Medicare Modernization and Prescription Drug Act (HR 4954) would allocate more than $21 billion over the next five years to avert the serious Medicare physician payment cuts.

The bill, part of a package that includes a Medicare prescription drug benefit, is not a long-term solution. It would require future congressional action to permanently repair the Medicare physician payment formula and avoid big reimbursement cuts in 2006 and beyond. But by giving lawmakers an additional three years to mend the broken formula, it takes an essential first step.

Now it's the Senate's turn to act. Lawmakers there pledged to pass a Medicare outpatient prescription-drug bill and to add a measure solving the Medicare payment crisis. But in July the drug benefit succumbed to partisan bickering, and a payment fix has yet to be offered.

Time is running out; Nov. 1 is just around the corner. Senators must act immediately to make sure a physician payment solution doesn't get dragged down by the Medicare drug benefit's defeat.

Doctors can help by contacting their senators, who are heading back into Washington after their August recess. Physicians should let them know that even one more year of Medicare payment cuts will break doctors' backs and disrupt Medicare patients' access to their doctors. The message is clear: The Senate must pass a payment package at least as strong as the House legislation. Sending that message is easy through the AMA's online Grassroots Action Center (http://www.ama-assn.org/go/grassroots).

Surveys by the AMA and others clearly show the damage that would result from a failure to act. The writing is on the wall; the Senate just has to read it.