Fighting Medicare cuts -- for our patients' future

A message to all physicians from AMA President J. Edward Hill, MD.

By J. Edward Hill, MDis a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06. Posted Nov. 21, 2005.

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Through advances in science, we have a chance to make 21st-century medicine the best in American history. Within our reach are better technology, better physician performance and higher quality care.

This is a vision that the AMA, the American people and our representatives in Congress should share.

Unfortunately, to reach these goals requires individual physicians to make new investments. All the while, at the same time, we continue to pay our staffs, run our offices and pay liability insurance premiums.

These recurring, out-of-pocket expenses, necessary to most any small business, will increase 15% by 2011, according to the government's conservative estimates.

These are the bills we have to pay just to keep our businesses up and running. And it's even harder for physicians with a lot of Medicare patients.

A main reason for this is that Congress has failed to replace the flawed formula that determines physician payments -- a formula based on the gross domestic product, which has no bearing on health care costs. And without a change to this flawed formula, physician payments for treating Medicare patients will be cut 26% over the next six years.

Two weeks ago, the U.S. Senate voted to include a 1% increase in Medicare payments in the federal budget reconciliation legislation. This increase would override the 4.4% cut scheduled for Jan. 1, 2006.

The AMA appreciates the Senate's efforts to prevent the 4.4% cut and to include a positive update, which inches Medicare closer to covering the costs of providing care. And we look forward to working with Congress to improve on this proposal.

But the battle is just beginning.

The fact is that this small increase would be little more than a Band-Aid placed on a hemorrhaging wound in the Medicare program.

While obviously better than a cut, the 1% increase in payment falls woefully short of covering rising medical practice costs.

The only way we can truly claim victory for Medicare patients and their physicians is to scrap the sustainable growth rate formula and in its place install an update that reflects actual costs of caring for the Medicare population. We would propose that such an update be tied to the Medicare Economic Index.

The Medicare Payment Advisory Commission agrees.

I speak from experience on this issue. I struggled with reduced payments in public programs for 27 years and finally had to give up a private practice in a part of the country with a predominantly Medicare/Medicaid population.

By keeping the flawed formula in place, it remains likely that many more physicians soon will be forced to pull back from Medicare, curbing access to care for some of our country's most vulnerable patients -- our seniors and the disabled. Rural areas could be hit especially hard.

And beyond access to care is realizing the dreams of medicine for the next century. Physicians want to make the investments in equipment and technology needed to bring the medicine of tomorrow to everyone in the country. But we can't do that if Medicare doesn't keep up.

And it's not just doctors who understand this. In the Oct. 25 Tucson Citizen, Anne T. Denogean wrote:

"Truth be told, we don't tend to think of doctors as 'the little guys' in need of our defense. But doctors in private practice are small-business owners. They have expenses that increase every year -- salaries, supplies, equipment, technology, rent and malpractice insurance. ...

"As for the doctors who continue to care for Medicare patients, they may have to take on more patients to maintain their revenue, which means the limited time you get with your doctor now would shrink even more. ...

"It's unfair to ask them to take a 26% cut. Ultimately, we're the ones who will pay the price when our calls for health care are met with: 'The doctor is not in.' "

For the health of our practices and, more important, the health of our senior and disabled patients, we need Congress to act now.

The AMA's campaign on the Medicare payment issue continues -- in order to stop cuts and to put health care for seniors and the disabled on a firm foundation.

But we need you to make this campaign work, and there's little time left in this session of Congress.

Please call 800 833-6354 or visit our Web site (link) to contact your senators and representative about this issue.

Tell them that the Medicare program as it is now cannot be sustained.

Urge your patients to go online to join the AMA's Patients' Action Network, and get involved (link).

The AMA wants to help doctors help our Medicare patients and set the stage for the medicine of the 21st century. Congress should, too.

J. Edward Hill, MD is a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn