Looming Medicare cuts viewed as threat

T.J. Greaney

Jul. 9, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- A congressional scuffle over reimbursement rates for Medicare is setting health care on edge. Physicians worry they could see a 10.6 percent pay cut this month if Congress doesn't step in and save the day. Medicare patients worry doctors will simply stop seeing them when it's no longer lucrative.

"People that don't have a supplement" to Medicare, "they could be in trouble," Pat Salane, 85, said yesterday at the Columbia Senior Center. "Doctors could close their practice to Medicare patients."

The concern is the product of a complex formula Congress put into effect in 1997 in an effort to balance the federal budget. Medicare spending is tied to gross domestic product. When Medicare spending rises above a certain level and the GDP fails to keep pace, reimbursement rates -- money paid to doctors by the Centers for Medicare and Medicaid Services -- must drop.

In each of the past five years, Congress has stepped in to prevent the cuts. So far this year, however, lawmakers have been unable to reach a consensus.

The cuts were scheduled to take effect July 1, but a temporary delay order will stall the cuts until July 15 unless Congress acts.

Jerry Kennett, a cardiologist at the Missouri Heart Center and a medical executive committee member at Boone Hospital Center, contends a 10 percent cut in the Medicare reimbursement would effectively be a 20 percent reduction of income for his practice because costs will stay the same or increase. He said 55 percent of his patients are on Medicare.

"It's going to be harder and harder for people to get in to see a physician," he said.

For example, Kennett predicted, a new Medicare patient in Columbia who is 68 and diabetic will find it nearly impossible to see a primary-care physician.

An American Medical Association poll this year found about 60 percent of physicians nationwide said they would limit the number of new Medicare patients they see if the cuts take effect.

Richard Royer, CEO of Columbia-based Primaris, Missouri's Medicare quality improvement organization, said the inability to see a doctor would be most devastating in rural areas.

"The primary-care physicians, that's all that's out there," Royer said. "A $5 cut for an office visit for a family doctor in Macon means an awful lot and can mean even more than a $100 cut to a surgeon in St. Louis."

Democrats in Congress proposed a way to prevent the cuts, in part by cutting Medicare Advantage Plan payments. Advantage plans are run by private insurers offering Medicare patients broader coverage options. The proposal passed in the House of Representatives but stalled in the Senate.

U.S. Sen. Claire McCaskill, D-Mo., sharply criticized Advantage plans, saying in a prepared statement they often charge seniors too much and actually provide fewer benefits than traditional Medicare. Medicare Advantage supporters, including U.S. Sen. Kit Bond, R-Mo., believe the plans are a way to leverage market forces to encourage competition and drive down health-care costs.

Royer thinks the solution should be somewhere in the middle. He would spread the cuts among Advantage plans, hospitals, nursing homes and Medicare's headquarters. He thinks a compromise is unlikely. "They kick the ball down the street for the next group of congressmen to argue about," he said.

Newstex ID: KRTB-0037-26547769