15 February 2008

Get ready for that 10% cut

This doesn't sound good.

Commentary: Senator Baucus is annoyed at the AMA, so he banned them from the hearings which will determine whether the 10% cut in Medicare professional reimbursements will be delayed/canceled. You may recall that, once more, Congress reached an eleventh-hour deal to postpone the cut in December, but only for six months, instead of the more typical one-year reprieve. So the issue needs to be re-visited this spring. My reflex is to get all indignant that our voice won't be heard at the table, but it's really not a big deal. The AMA is a terribly ineffective advocate for physicians on Capitol Hill, there are plenty of other advocacy and specialty groups to speak for us, like the AARP, and the position and needs of physicians are well enough known that the AMA, while not exactly superfluous, is expendable in this case. If it appeases Baucus to make the AMA the sacrifical lamb this year, it's worth it.

More concerning: "House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) on Thursday said that he doubts Congress would be able to find the money for a patch and that the cut would go into effect." Ruh-roh! I don't know too much about Pete Stark, except that his name is on a piece major legislation that greatly complicates and restricts the financial relationships between physicians and hospitals. He does not seem open to the needs of physicians; though, FWIW, he is quoted as saying that they want to take a comprehensive look at creating a whole new payment system. It sounds kind of scary to me, but if he's looking at fixing the SGR, we need to make nice to him and keep him on our side.

If the 10% cut goes through, it will be an unmitigated disaster. There will be a lot of Medicare patients who do not have doctors. If there are any readers of this blog who live in CA-13, the Oakland area, I'd make it a point to give a call to Rep Stark's office or send him an email.

For that matter if you live in any of the districts represented by the W&M Health members, give their office a call. Be polite and make sure they know how concerned you are that access to care for Medicare beneficiaries will be severely impacted by the 10% cut.

Baucus, for what it's worth, does seem more attuned to the need to stop the cuts in the short term.


  1. As I understand it, as an ER doc, you are mandated to see all patients that come to the Emergency Room. So what happens if the government continues to cut Medicare reimbursement? Can you refuse to accept Medicare and bill senior citizens a fair amount directly, or are you forced to take whatever Medicare wants to give you?

  2. What will happen, as an ER doc, is that his ER will be even more overflowing as those with Medicare who can't find doctors will come to his, or any other ER, for care. Unfortunately, those in the ER, Anesthesia and the like will have to bend over and take the cuts, as they have to participate in Medicare. Those of us who see patients in the hospital will have to take the cuts. But, I can just say no to those office patients with Medicare, as there's no obligation to see these patients. The whole reimbursement issue in NJ is worse when Medicaid is the secondary,as the Legislature mandated that the state won't pay the 20% (ain't no money), and we can't balance bill. I really can't wait for the cuts to go through, as the whole system needs to crumble before it can be fixed - and in an election year, yet.

  3. I sent this message to Mr. Stark; I'd be interested if anyone has thoughts on the comment.

    Dear Mr. Chairman,

    I am a former intern of your subcommittee, and a current medical student in California. My time with Ways and Means taught me a great deal about the difficulties that Congress faces in financing Medicare, and that altering physician reimbursement is an essential component of Medicare finance reform. With that in mind, I must strongly urge you to reconsider your position on the 10% cuts forthcoming to physician reimbursement. Such a cut will decrease access to healthcare providers for Medicare recipients; this is a given. More importantly, it doesn't address the problems associated in a fee-for-service finance system; healthcare providers will compensate for the cuts in a variety of ways other than reducing their number of Medicare patients, including booking more appointments and spending less time with each patient. In this age of chronic disease and multiple co-morbidities, polypharmacy, and complex mental health issues, reducing the time that providers can spend with their patients has negative consequences for every patient in this nation, and particularly for your constituents 65 and older. I strongly urge you to take action to prevent the 10% provider cuts, and instead to focus efforts on addressing the systemic problems in Medicare finance.

    Med Student X

  4. shadowfax,

    did you see this thread on Stark and Medicare a while ago on Kevin M.D.? gives some perspective on what Stark thinks about the cuts.


  5. Anon 4:23,

    ismd is right. Most hospital-based physician groups are obligated as a position of their hospital contracts to accept medicare (and any other payers the hospital wants to require).

    Anon 12:28,

    Yeah, I saw that. The pity is that he clearly does not understand the access crisis. I don't think that docs will drop medicare in droves (might happen, but I doubt it). But they will just limit the number of slots in the clinic for medicare patients, just as they do for medicaid patients, with the effect that medicare patients who for whatever reason need to find a new doctor can't find one who will see them.

    It's already happening, to some degree, and will just get worse as the reimbursements drop (or fail to keep pace with inflation in costs).

  6. As an anesthesiologist, we would be forced to accept the cuts. That said, eventually we would no longer be able to hire or retain staff and service. One option would be to demand the hospital pay for services it is required to delivery to the community, but MDs are no longer reimbursed for. THe bottom line eventually the availability for some services would be reduced or eliminated.


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