Medicare Meltdown Forcing Physicians Out

Facing either a freeze in Medicare payments or cuts ranging from 2 percent to nearly 30 percent, almost half of Texas physicians are considering opting out of the Medicare program altogether, putting seniors, military families, and people with disabilities at serious risk of losing their doctor, a Texas Medical Association survey [PDF] shows.

"The number of Texas physicians who may be forced to leave Medicare if Congress doesn't fix the program is staggering," said TMA President C. Bruce Malone, MD. "It's tragic. Medicare simply cannot work without physicians to care for the millions of patients who depend on it. Congress can't wait any longer."

Dr. Malone has a message he wants you to deliver to U.S. Sens. John Cornyn and Kay Bailey Hutchison and your U.S. representative: It's time to stop treating physicians like the low profession on the Medicare totem pole.

"For the past decade, Congress has recognized the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care professionals provide Medicare patients," Dr. Malone wrote to all TMA members. "They all have received annual payment updates. Physicians should, too. Before any future updates are given, Washington needs to fix the broken physician payment system."

Please use the TMA Grassroots Action Center to deliver Dr. Malone's message to Congress today. We're also activating our Me and My Doctor networking, asking your patients to make the same request to replace the broken SGR formula before pouring more money into other Medicare providers' payments.

Thanks to the Sustainable Growth Rate (SGR) formula that determines Medicare fees, payments to physicians will drop 29.5 percent on Jan. 1 unless Congress intervenes. Earlier this month, the Medicare Payment Advisory Commission (MedPAC) voted 15-2 in favor of repealing the SGR but freezing payments to physicians to offset the estimated $200 billion cost. The MedPAC plan  [PDF] freezes Medicare rates for most primary care physician and cuts other physician services by 5.9 percent for three years, then freezes them for seven years. To compound matters, if the congressional Joint Select Committee on Deficit Reduction can't trim $1.2 trillion in federal spending by Thanksgiving, physicians will face an additional 2-percent cut to their Medicare payments beginning in 2013.

"We knew some physicians would consider leaving the program, but we didn't think the number would be that high," Dr. Malone said of the TMA survey results. "Even considering a possible 'compromise cut' of 10 percent, physicians' responses were the same – they would be forced to leave Medicare."

Dr. Malone, an Austin orthopedic surgeon for 37 years, might be one of them. "I might have no choice but to retire early. More than half of my practice consists of Medicare patients," he said. Last year, his medical group laid off staff to help make ends meet.

The gaping problem has eroded access for both Medicare and Medicaid patients. One-third of all Texas physicians put limits on new Medicaid patients. Medicaid access would suffer even more if Congress lets the Medicare cuts go through. More than one-quarter of Texas physicians say they will impose more Medicaid limits if the cuts occur; another 27 percent are considering such limits. Although rates for the two programs aren't connected, physicians are likely to leave Medicaid – whose payment rates are significantly worse – if the Medicare cuts further erode their practice's financial viability.

The only way to stop the cut is for Congress to fix the defective SGR. Because of flaws in its design, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. Without a permanent solution, the size of the cuts continues to grow.

Action, Oct. 17, 2011