Medicare payment -- past, present, future: Promise and challenges

Despite the big money problems that sit in the way, physicians are trying to look at what lies beyond repairing the Medicare pay system. Last in a 3-part series.

By David Glendinning, AMNews staff. Oct. 9, 2006.

MEDICARE PAYMENT Past - Present - Future  Prelude to a crisis (Sept. 25)  A "rational" system unraveled (Oct. 2)  Promise and challenges (Oct. 9)

Like many physicians, Richard B. Warner, MD, is eager for policy-makers to fix what's wrong with Medicare so doctors can get back to focusing full time on what's right with the program.

"We may all wish for a higher level of remuneration for what we do, but there's no doubt that Medicare has allowed physicians and their patients to chart a good course for the patients' treatment," said Dr. Warner, a psychiatrist from Overland Park, Kan., and Kansas Medical Society president. "For most of its time, it really has given patients the freedom to choose where and how they receive their aging care."

But stagnant federal reimbursements, the constant threat of rate cuts, increasing practice costs and heightened strains on time are convincing some physicians to back away from the program they say has served so many seniors and patients with disabilities so well in its 41 years. Some say their dedication to the patients under the program's wing is the only reason they didn't make the logical decision to walk away from it years ago.

Instead of being able to concentrate on improving patient care and preparing for the next big generation of seniors to come, physicians must expend most of their political energy battling the next expected Medicare reimbursement cut that is almost always less than a year away, said David A. Ellington, MD, a family physician from Lexington, Va.

"We play chicken every year with the budget, and every time it goes down to the last minute before Congress comes in to fix it," said Dr. Ellington, past president of the Medical Society of Virginia, who recently traveled to Washington, D.C., as part of an American Medical Association campaign to stop Medicare pay cuts. "Then we start all over again."