Physicians press lawmakers to stop Medicare pay cuts

Washington -- Nearly 1,000 physicians convened in Washington, D.C., earlier this month to help lobby lawmakers on Medicare payment reform in the face of a tight timeline and an even tighter budget.

Although the American Medical Association's National Advocacy Conference covered a range of health policy issues, its main focus was on patching the Medicare payment system that otherwise will cause a 10.6% reduction in doctor pay starting July 1. The event featured congressional speakers and an opportunity for more than 100 physician and medical student attendees to meet with lawmakers following an April 2 rally on Capitol Hill.

During the rally, white-coated physicians held up signs calling for action on the Medicare issue and chanted, "We care, be fair."

Shelley C. Glover, MD, a Florida gynecologist, said afterward that she planned to warn her congressional lawmakers about the difficult decisions physicians are being forced to contemplate under the threat of rate cuts. Her practice decided in 2006 to stop accepting new Medicare patients, and she fears that a double-digit cut would cause her to stop seeing Medicare patients altogether. "We have new patients calling up every single day looking for a gynecologist, and they can't find one in my town," Dr. Glover said. "It's horrible, but we just can't afford to do it."

Mary S. Carpenter, MD, a family physician in Winner, S.D., said that some areas of the country would be hit especially hard by rate cuts. South Dakota physicians, for instance, already receive some of the lowest Medicare rates in the country. Doctors there who are nearing retirement age face the "nearly impossible" task of recruiting new physicians to take their places, she said. Payment reductions would make the effort even more difficult.

AMA President-elect Nancy H. Nielsen, MD, PhD, said it was remarkable that so many physicians came to Washington to press the Medicare issue themselves.

"There are patients at home that are not having our services today," she said. "This is so important that surgeons, psychiatrists, internists ... we all came here to the halls of Congress to say, 'Remember the promise you made to our seniors; now it's your job to keep that promise.' "

The response from Capitol Hill

As they prepared to share their stories on Capitol Hill, physicians attending the conference received updates from several lawmakers on a possible legislative response. Sen. Jon Kyl (R, Ariz.), said that most of his colleagues were leaning toward passing an 18-month patch that would prevent the upcoming cut from taking place and that would provide for a modest rate increase in 2009.

Kyl warned, however, that such an action would likely set up an even larger cut in 2010. The Congressional Budget Office in March estimated that keeping Medicare rates steady for the rest of this year and providing a 1% boost in 2009 would cost $37.5 billion over five years. But Congress could reduce that price tag to $8.4 billion if it allowed for a 21% cut to physician pay in 2010.

"You begin to get the drift here?" he said. "If something is $30 billion cheaper than the alternative, Congress is more likely to search for the easier solution."

In addition, even such a short-term solution still could be torpedoed if lawmakers attempt to attach billions in new spending in other health care areas, Kyl said. He said the 18-month patch might turn into a six-month measure if Congress struggles to find the necessary financial offsets for more controversial spending proposals. This would require lawmakers to act again by the end of December on physician payment or else allow a cut to go through at the beginning of 2009.

"Is the physician update for the next 18 months ... worth it to not have additional new spending, as is being proposed by some in Congress?" he asked. "There's a trade-off here."

The AMA supports a bill authored by Sen. Debbie Stabenow (D, Mich.) that would prevent the 10.6% cut from occurring July 1 and give doctors a 1.8% raise in 2009 based on the projected increase in the cost of practicing medicine. CBO estimates that solution would cost nearly $40 billion over five years.

Senate Finance Committee leaders are working on a bill they may take directly to the Senate floor rather than mark up in committee first, according to congressional aides. This tactic could save time but might leave physicians in the dark about what Congress wants their payment rates to be until much closer to the July 1 deadline.

Regardless of how Congress acts within the next 90 days or so, the cycle of last-minute, temporary payment patches must end someday, said Sen. Tom Coburn, MD (R, Okla.), who also addressed the conference. He warned that physicians might not like the way that the cycle is broken.

"As good a job as the AMA does, you're going to eventually get a 10% cut," he said. "It's going to happen, and maybe that will finally motivate the medical community in this country to start getting back in charge."