The Texas Medicare Manifesto II

By TMA President Josie R. Williams, MD

Every year, for almost a decade, organized medicine and Congress go through the same tedious motions. Physicians plead with Congress: "Fix the faulty funding formula Medicare uses to pay physicians: Make it fair." The current payment system ensures that hospitals, nursing homes, pharmaceutical companies, Medicare HMOs, and many other Medicare providers receive an automatic cost-of-living increase. Meanwhile, doctors - the frontline people who take care of sick and injured Medicare patients - have to scramble to avoid dramatic pay cuts. Medicare patients, especially the elderly, struggle as more physicians who no longer can afford to take new Medicare patients leave the program.

From the beginning of 2007, Congress knew physicians were facing a 10-percent cut starting January 2008. However, instead of coming up with a permanent, long-term solution, Congress at the last minute, in December 2007, slapped on a six-month Band-Aid. By the time Congress finally took action to stop the cuts (but not really fix the system) on July 15, 2008 - 18 months from when the problem first arose - cuts of more than 10.6 percent had gone into effect. Even though Congress had promised physicians and patients it would stop the cuts before they took effect, when it came down to the final hour, the U.S. Senate failed to pass the measure. Instead, the Senate played partisan politics. Its lack of action compromised millions of Medicare patients.

Tired of the broken promises and partisan antics, organized medicine put our political muscle to work. Medicine united - all specialties. We engaged the media across the nation and, more important, our patients. Together we demanded that the U.S. Senate do the right thing for senior citizens, military families, and persons with disabilities and stop the 10.6-percent cut. It worked. The Senate finally passed House Resolution 6331, and then Congress overrode a presidential veto . The Senate finally passed House Resolution 6331, and then Congress overrode a presidential veto. The bill stopped the cuts and gave Congress 18 months to devise a long-term replacement for the Sustainable Growth Rate financing formula, as we insisted in the Texas Medical Association's Texas Medicare Manifesto.

Long-Term Solution Desperately Needed

Now TMA and our patients call upon leaders on both sides of the aisle to stop stalling. It's time to get to work and develop a bipartisan, long-term solution to the Medicare financing fiasco.

We know Congress is going to stall. It has many reasons to put off fixing the Medicare crisis, such as the presidential election, holidays, presidential inauguration, and the White House transition. It is very unlikely that Congress will begin to consider any legislation to fix Medicare until March 2009 or later. That leaves only nine months for Congress to fix a monumental problem it has neglected for more than a decade. And there's another steep cliff looming ahead. If Congress once again does nothing, physicians are looking at a pay cut of 20 percent or more on Jan. 1, 2010. Soon the cost of the short-term fix will equal or exceed the cost of the long-term solution.

Texas Medicare Manifesto II

We must hold the government accountable for the promises it made to help us care for our elderly patients and Texans with disabilities. We are asking our U.S. representatives and senators to:

Fix the Formula Now

We need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.

Physicians have carried the Medicare program for the past decade at the expense of our own practices. In addition, most health insurance companies base their payments to physicians on Medicare rates. Therefore, every time Congress freezes Medicare rates, health insurance companies gladly do the same (although they don't bother to freeze the premiums our patients and their employers are paying).

Physicians want to take care of our frail and elderly patients. It's ironic that the federal payment system these patients rely on for care is the same one forcing physicians out. The government is forcing physicians to choose between taking care of needy patients and keeping open the doors of the practice.

Rebalance Funding Across All Parts of Medicare

Medicare funding should follow the way Medicare patients receive care. Physicians' offices are the front door to health care. We are the first to see, treat, and manage a Medicare patient's care. Congress needs to recognize that physicians are the bedrock of the Medicare program.

Neither hospitals, nursing homes, insurance-company Medicare Advantage plans, nor any other Medicare provider should receive an update until the physician payment system is addressed once and for all - for the benefit of ALL Medicare patients. If this means "breaking down the silos" among Medicare Parts A, B, and D, so be it.

Medicare funding is a byzantine maze of trust fund, enrollee premiums, and tax dollars. The system that was put in place 40 years ago never anticipated the advances in medical treatments or where those treatments would be delivered. The program and its funding have to change with the times. Funding should follow services, particularly when they move from costly inpatient to less expensive outpatient settings.

It's time that Congress restores integrity to the Medicare program. The program promised insurance to the elderly. Now it needs to live up to that promise by ensuring that physicians are available to care for these patients, today and tomorrow.

Put Patients Before Insurance Companies

Private health insurance companies should NOT come ahead of patient care. Medicare Advantage plans run by private health insurance plans and Medicare HMOs are receiving double-digit, multimillion-dollar bonuses simply for arranging existing medical services. These critical health care dollars should be used for health care, not health insurance corporate profits, especially because physicians - not insurance companies - do the heavy lifting in taking care of patients enrolled in these plans.

It is time that we correct the erroneous impression and ease the fear patients have about losing their Medicare coverage. Make it clear to seniors that even if they enroll in a Medicare Advantage plan and that insurance company later decides to withdraw from the program, they will always be eligible for traditional Medicare coverage.

Physicians also should be given the same payment for disease management programs as private health insurance companies that run some Medicare Advantage plans. Why should the government pay private health insurance companies more than physicians for disease management, pharmaceuticals, and capital investments? Physicians are the ones who actually manage our patients' care and their multiple chronic illnesses - insurance companies manage profits.

Physicians and Patients Must Force Congress to Fix Medicare, Once and for All

Here is what you can do, starting today.   

We simply cannot sit back and wait for Congress to act. If history repeats itself, which it most likely will - Congress is going to postpone taking any action and slap yet another Band-Aid on the problem. We, all of us, including our patients, must force Congress to take "real action" and fix the Medicare payment system. Together, we forced Congress' hand in July to stop the cuts and override a presidential veto - we can do it again. Here is what you can do, starting today:

Contact  all Texans in Congress - both Democratic and Republican members.

  • Thank them for stopping the cut to physician payments in July.
  • Ask them to start working on a long-term fix right now. At the very least, they must come up with a way to rebalance the funding silos used to pay hospitals, insurance, and drug companies so everyone is paid fairly.
  • Tell them that no Medicare provider should receive an update until the physician payment system is permanently fixed.
  • Ask our Texas delegation to support legislative measures proposed by U.S. Rep. Michael Burgess, MD (R-Texas), and U.S. Sen. John Cornyn (R-Texas) calling for reforming Medicare and permanently fixing the flawed funding formula used to pay physicians.
  • Tell Congress it must act before the end of 2009 so Medicare patients can continue to receive quality care by their physician.

Action , Dec. 1, 2008


Comment on this (Must be logged in to comment)

Add Comment

Text Only 2000 character limit

Looking for more?