Government

AMA steps up education efforts to patients, Congress to show impact of Medicare pay cut

An Association survey of health care consumers showed that most were unaware of the upcoming reduction but are worried by the prospect.

By David Glendinning — Posted Sept. 25, 2006

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The American Medical Association earlier this month turned up the volume on the upcoming Medicare pay cut to doctors, organizing a major physician fly-in to Washington, D.C., and launching an advertising campaign aimed at educating lawmakers and uninformed constituents about the dangers of inaction.

Hundreds of physicians from all over the country, representing multiple specialties, planned to descend on the nation's capital in the second half of September to protest the projected 5.1% reduction set to go into effect in January. Through Capitol Hill visits and media events, the participants hope to inform patients and persuade lawmakers to reverse the cut before Congress adjourns in early October to prepare for mid-term elections.

A recent AMA survey indicated that the issue had not caught the attention of a majority of health care consumers who otherwise might be expected to put pressure on lawmakers themselves. But once consumers were made aware of the looming cuts, they expressed concern over what that could mean for access to physician care.

In the survey of more than 1,000 adults conducted in July, roughly 70% of the respondents said they did not know that a round of annual Medicare cuts to doctors was set to begin in January 2007. When informed about the details of the reductions, 86% said they thought access for Medicare patients could be hurt as a result.

Baby boomers, who will start to retire in five years, are especially worried. About 93% of survey participants age 45 to 54, for example, said they were concerned about the negative impact of the changes on access to Medicare physician services.

Part of the difficulty facing physicians is that constituents and even lawmakers can experience "issue fatigue," in which important messages can be lost amid all the other legislative activities that occur late in a congressional session, said AMA Board of Trustees member William A. Hazel Jr., MD. He said the survey results show that while physicians need to be diligent about getting the word to patients and lawmakers, the message resonates once it does get out.

"I'm not sure it's a simple message, and I'm not sure people understand what it means. ... Every year you hear Congress is cutting this and doing that, and it's so hard to know what they're talking about," he said. "But this comes down to some very real dollars and some very real access issues."

In addition to meeting with lawmakers on Capitol Hill, the AMA is encouraging patients to contact legislators through the "Patients' Action Network," an online resource that at press time had generated more than 560,000 contacts with Congress urging action to block the Medicare cut.

The Association also is spending $1.5 million on an advertising blitz aimed at educating patients and spurring lawmakers to action. Print ads are running in national magazines as well as inside-the-beltway publications that focus on politics.

The new ad running in Washington, D.C., features an image of a stopwatch accompanied by a caption that says, "Time is running out." The ad concludes that Congress must pass legislation blocking the cut before adjourning for the elections. It also encourages readers to access the Patients' Action Network Web site to pass that message along.

Making tough choices

The physicians making rounds on Capitol Hill will stress the difficult choices they might have to make if the Medicare reduction takes effect.

"We are here to share the fact that some family physicians are facing actual bankruptcy," said Larry S. Fields, MD, American Academy of Family Physicians president. "Many may be forced to close their doors to new Medicare patients, and some will leave practice entirely if payments are cut by 5.1%."

The Medical Group Management Assn., whose members run physician practices, earlier this month released its own survey detailing the steps that practices plan to take if the cut is not blocked. Nearly 40% of the more than 1,600 practices surveyed said they would limit the number of Medicare patients they see. Nearly 20% responded that they would stop accepting new Medicare patients altogether.

"It's vital that Medicare beneficiaries have adequate access to the full range of medical services in their communities," said MGMA President William F. Jessee, MD. "But if medical practices are to continue providing high-quality care, they may have to make some very painful decisions in order to stay financially viable."

Such decisions to cope with a cut wouldn't affect just Medicare beneficiaries, the MGMA said. More than two-thirds of survey participants said they would modify or eliminate health benefits for staff members. More than half plan to eliminate staff jobs on the administrative and support side, and nearly 40% said they will reduce clinical staff if the cut goes through.

Meanwhile, early October might not be the last chance for Congress to block the 2007 reduction. If lawmakers do not act before adjourning then, they could do so in a possible lame duck session after elections or even early next year after the new Congress convenes. The 2006 Medicare pay cut, for example, was in effect for about a month before lawmakers approved a retroactive rate freeze.

But waiting to intervene until weeks before the end of the year or until after the cut already has taken effect will be too late for some doctors, Dr. Hazel said. To function as successful small businesses, many practices must decide soon whether they will participate in the Medicare program next year, he said. Physicians can officially change their participation status between Nov. 15 and the end of the year, though Congress could extend that period if they reverse the cut after the new year has already started.

"Congress needs to act now," Dr. Hazel said. "September is a good time to know what to expect in January."

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ADDITIONAL INFORMATION

AMA health consumer survey

The government plans to decrease payments to physicians for Medicare patients by 37% over the next nine years. At the same time, the cost to provide this health care will increase by 22%. Many physicians may have to stop seeing Medicare patients because they will not be able to cover the increased cost of providing care. Were you aware of these impending Medicare physician payment cuts?

Yes: 30%

No: 69%

Don't know: 1%

How concerned are you that access to health care for Medicare patients will be hurt because government payments to physicians will fall far below the increased cost of caring for seniors? Would you say you are ...

Very concerned: 60%Somewhat concerned: 26%Not very concerned: 8%Not at all concerned: 4%

Don't know: 2%

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External links

AMA Patients' Access Network, a resource to connect patients to legislators on physician issues (link)

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