Congress rebuffs Bush on Medicare Doctors won't face reduction in funding

Jerry Zremski

Jul. 16, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- WASHINGTON -- A battle between Congress and President Bush over Medicare funding culminated Tuesday with a presidential veto and a quick override of it, but Western New York doctors said they're still among the recurring battle's worst victims.

The bottom line is that physicians probably won't have to suffer the 10.6 percent cut in Medicare payments that the Bush administration had been pushing -- but that's little comfort in an area where frustration with Medicare is one of many factors contributing to a physician shortage.

"For guys like me who grew up here, we're going to stay here," said Dr. Edward K. Bartels, president of the Medical Society of Erie County. "But to other physicians from out of town, it is very different. They don't want to practice here, and that makes it very hard to get in to see a primary care physician these days."

The unusually huge number of local residents on Medicare, along with the low reimbursements doctors receive for caring for them, combine with several other factors to make Western New York a less-than- attractive place to many young doctors, Bartels said.

What's more, there's evidence that the region's poor medical economy is driving physicians out of town. Last year, the Medical Society sent endorsement letters for 54 doctors who wanted to leave -- up from 20 the year before.

One big reason behind that is the perennial issue the president and Congress revisited Tuesday: how much doctors get paid for Medicare services.

In an effort to forestall a 10.6 percent cut in Medicare payments to doctors, Congress recently passed a bill instead trimming payments to "Medicare Advantage" programs: health maintenance organizations that have been paid 12 to 19 percent more than physicians are for caring for Medicare patients.

But Bush vetoed the bill, saying he didn't want to hurt the HMOs.

"I support the primary objective of this legislation, to forestall reductions in physician payments," Bush said in a message to Congress. "Yet taking choices away from seniors to pay physicians is wrong."

Congress saw things differently. The House almost immediately overrode Bush's veto by a vote of 383-41, and the Senate quickly followed suit in a 70-26 vote.

"The president's misguided veto threatens to deny access to Medicare services for millions of seniors and people with disabilities," said Rep. Louise M. Slaughter, D-Fairport.

An echo of that debate can be heard in Western New York, where Medicare Advantage plans such as those offered by Independent Health and Blue- Cross BlueShield of Western New York are likely to suffer a funding cut.

The bill that's now likely to become law "unfortunately pits seniors enrolled in Medicare Advantage plans against physicians," said Michael W. Cropp, president and chief executive officer of Independent Health. "Cuts to Medicare Advantage will result in limitations in benefits and choices that those seniors enrolled in such plans currently experience."

Cropp said that's particularly true for not-for-profit organizations such as his, but the president of the American Medical Association, Dr. Nancy H. Nielsen of Buffalo, noted that organizations representing patients and physicians alike supported the bill.

"The only group opposing the legislation is a health insurance lobby eager to protect health plan subsidies and profits," Nielsen said.

The Health Care Association of New York State said Bush's veto could have cost New York health care (OTCBB:BBAL) providers up to $1 billion in reimbursements.

And physicians stressed that the fight over the bill masks a larger debate over how much physicians and HMOs have been paid for Medicare services over many years.

Physicians have received minimal reimbursement increases over the years, and that puts unusual pressure on physicians in areas that have especially large numbers of seniors, such as Western New York, said Christine C. Ignaszak-Nadolny, executive director of the Erie County Medical Society.

Doctors have to spend more time with elderly patients, compounding the reimbursement issue. Meanwhile, doctors in New York State have to pay more for malpractice insurance, and face unusually strict state oversight.

Combined, those factors led to a 10 percent decline in the number of doctors in the Buffalo Niagara region between 2001 and 2005, according to a study done at the Center for Health Workforce Studies at the State University at Albany.

"New physicians look at all of this and say: Do I really want to stay in New York State?" Ignaszak- Nadolny said.

But in trying to preserve payments to doctors by cutting payments to Medicare Advantage programs, Congress is creating another problem, said HMO advocates, who note that those entities provide higher payments because they offer fuller services than regular Medicare.

"These cuts would really threaten the program and result in some reductions in the benefits the [Medicare Advantage] plans could provide," said Donald Ingalls, vice president/ government affairs at BlueCross BlueShield of Western New York.

Sen. Charles E. Schumer, D-N. Y., strongly supported the bill preventing the cuts to doctors, as did Sen. Hillary Rodham Clinton, D-N. Y., and Rep. Brian Higgins, D-Buffalo.

But Schumer acknowledged that a bill preventing a cut in payments to physicians is not enough to fix the system.

"We risk losing good doctors in Western New York if Medicare payments aren't enough to cover their costs," Schumer said. "The current payment system is antiquated and overdue for reform. It needs to be updated to adjust for the rising costs of health care so patients don't get shut out."

jzremski@buffnews.com

Newstex ID: KRTB-0019-26700558