Doctors want pre-election payment fix

A Nov. 1 announcement of the 2003 cut could drive physicians from the Medicare program.

By Markian Hawryluk, amednews staff. Oct. 28, 2002.

Washington -- In the waning days before the November elections, physician groups increased the intensity of the drumbeat for a Medicare physician payment fix.

Medicare physician reimbursement is expected to drop 12% in the next three years if Congress fails to pass legislation to prevent the reductions.

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"Unless Congress acts by Nov. 1 when the Centers for Medicare & Medicaid Services announces the next round of cuts, more physicians will be forced to make the difficult decision to stop taking new Medicare patients into their practices," said Donald J. Palmisano, MD, president-elect of the American Medical Association.

Physicians already sustained a 5.4% cut in 2002 and face an additional $11 billion reduction in Medicare payments from 2003 to 2005.

At that time, Dr. Palmisano said, physician rates would have dropped to below 1991 levels, despite more than a decade of medical inflation.

A host of surveys conducted this year have found that doctors across the country have reduced the number of new Medicare patients they'll see or closed their doors to them altogether.

"Unfortunately, these access problems are just the tip of the iceberg, with more than two-thirds of the payment cuts yet to come," Dr. Palmisano said at a media briefing on the Medicare situation. "When the AMA asked physicians if they would continue to sign Medicare participation agreements if there were more payment cuts, 42% said they would not."

Physicians must choose by Dec. 31 whether to participate in the program and to accept the Medicare rate as payment in full. But Dr. Palmisano believes many will make that decision as soon as the cut is announced.

Congress would be taking a chance by waiting until after the elections to address the update problem, he said.

"Actions may have already been taken by physicians, and it's sort of late to undo those decisions," Dr. Palmisano said. "They have to plan for the future ... and make sure the practice remains viable."

Support in Washington

The Bush administration has urged Congress to address the payment formula. The House passed a $30 billion package earlier this year that would replace the cuts from 2003 to 2005 with modest increases each year. The House measure also included a Medicare outpatient prescription drug benefit.

The Senate has been unable to agree on a Medicare payment package. Sens. Max Baucus (D, Mont.) and Charles Grassley (R, Iowa) have proposed a $41 billion bill that includes the House-passed update fix.

But that measure contains only Medicare practitioner payment provisions and has been criticized by Republicans in Congress and the Bush administration as too expensive. Many senators also are unwilling to vote for Medicare payment increases before the election without also passing a prescription drug benefit.

The AARP has been a vocal critic of practitioner payment increases, saying a prescription drug benefit should be Congress' top priority. But in a letter to Senate Majority Leader Tom Daschle (D, S.D.), AARP Executive Director and CEO William Novelli indicated that his members do not oppose addressing the physician payment issue.

"Our members want providers who treat Medicare patients to be paid fairly," he said. "Errors or miscalculation in Medicare payment formulas should be corrected."

CMS Administrator Tom Scully has urged senators to limit Medicare provisions in upcoming legislation to fixing the physician payment rates and allowing states to retain unused State Children's Health Insurance Program funds next year.

Daschle said the Senate had a 50-50 chance of passing an update fix this year.

Dr. Palmisano said a continuing budget resolution, temporarily funding the government until permanent appropriations bills can be passed, could be the best vehicle for passing the payment fix this month.

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