Congress misses another chance to fix Medicare SGR

A message to all physicians from AMA President Peter W. Carmel, MD.

By — Posted Jan. 2, 2012.

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Our nation is facing a crisis in the Medicare program that only lawmakers can stop, but once again Congress has missed the opportunity to do right by military families and senior citizens. Not to mention the physicians whom they count on for care.

Congress had the entire year to repeal the broken physician payment formula and provide stability for the millions of seniors and military families who rely on Medicare and Tricare but has failed to act. It is long past time for members of Congress to act decisively and protect access to care for seniors and military families.

Since 2002, the flawed sustainable growth rate formula has annually called for reductions in Medicare reimbursements. Congress has intervened a dozen times to prevent those cuts, yet over the decade, the temporary patches have not kept up with growth in practice costs. Today there is a 20% gap between Medicare payment updates and the cost of caring for seniors.

Congressional unwillingness to fix the SGR formula actually attacks the very core of American health care: that is, how can members of Congress expect physicians to improve our health care system when their continued unwillingness to address SGR is essentially driving the doctors out of Medicare and Tricare?

Congressional failure to address the cuts head-on eventually will devastate Medicare as we know it because physicians simply will not be able to afford to take on new Medicare patients.

Ironically, this failure on the part of Congress is happening as the aging baby boomer generation becomes eligible for Medicare ? at a rate of more than 10,000 per day. That is a lot of Medicare patients to care for -- especially when fewer physicians are opening their doors to those older than 65.

Already it is not uncommon for physicians to participate in Medicare only at a level that allows them to continue caring for long-time patients. As far as the rest are concerned, a recent survey showed that one in four seniors looking for a new physician is having trouble finding one. Specialists such as cardiologists and gastroenterologists can be even more difficult to find. I have written in the past about my colleagues who are seeing "reverse commuters" -- retired patients coming back annually because they cannot find physicians to treat them in their new homes.

The Medical Group Management Assn. -- an organization of those who oversee medical practices -- recently reported on a survey of more than 2,000 medical groups representing nearly 100,000 physicians. More than 95% of those who replied now participate in Medicare, yet when asked what would happen if Congress has not intervened to avert the Medicare cut, more than half said they would reduce the number of new Medicare patients they accept -- and 30.9% said they would stop taking new Medicare patients all together.

I find all this infuriating, but also puzzling, in part because an overwhelming majority of Congress ? Democrats and Republicans alike ? are on record stating that the Medicare physician payment formula should be repealed. They understand the dilemma that physicians face. They "get it" that that if the costs of treating Medicare patients exceeds the money coming in, certain decisions have to be made.

Members of Congress have heard from their constituents on the subject. Hundreds of thousands of letters have been sent and phone calls have been made over the past several years. Dozens of physician organizations and groups like AARP and the Military Officers Assn. of America all have urged Congress to vote on SGR -- and save Medicare for seniors.

Both the final report of the Simpson-Bowles Commission and recommendations of the Senate bipartisan "gang of six" included funding to permanently reform the SGR formula. It can be done.

More than 100 members of the House of Representatives from both parties signed a letter to the congressional Joint Select Committee on Deficit Reduction asking for full repeal of the SGR.

As an alternative, the AMA has come out in support of bills that would allow Medicare patients to continue receiving Medicare benefits, and the physician would be able to "balance bill" the patient for the remaining amount agreed upon in the contract.

But all to no avail.

Over and over, Congress has failed to live up to the commitment it made when it created Medicare -- to preserve access to high-quality health care for America's seniors and military families.

But I also wonder why Congress would fail to act decisively on an issue that so directly affects our nation's senior citizens, who make up the country's largest voting bloc. In the 2010 election, senior citizens accounted for 23% of the votes cast, up from 16% in 2008. This number -- already nearly 1 in 4 voters -- will be only higher in the coming election. Every 10 seconds for the next 18 years, someone will turn 65. And these voters are exactly the same people Congress is in the process of disenfranchising as a result of their failure to fix SGR.

Congress created the Medicare physician payment system. Now Congress needs to fix it -- once and for all.

In the meantime, regardless of how and whether they decided to participate in Medicare this year, many physicians I know are agonizing over how they will be able to provide care for Medicare patients -- and whether they will be able to keep their practices open at all.

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