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
. 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
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
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
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
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,
all Texans in Congress - both Democratic and
- Thank them for stopping the cut to physician payments in
- 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
- Tell Congress it must act before the end of 2009 so Medicare
patients can continue to receive quality care by their
, Dec. 1, 2008