Knifing Doctors and Seniors

Approaching the 11th hour on reconciling the ObamaCare "doc fix."

A jarring 94 percent of Americans are worried about a looming Medicare cut in reimbursements to doctors, the American Medical Association found in a poll it released Nov. 8. Unless Congress acts quickly, doctors caring for Medicare patients are looking at a 23 percent reduction in pay for treating seniors at the end of this month. On Jan. 1, an added cut is supposed to take effect.

It “will be catastrophic for seniors who rely on the Medicare program,” AMA President Cecil Wilson said at press conference at a physicians’ meeting in San Diego. Both seniors and physicians should be boiling mad at continual Congressional dithering on the Medicare reimbursement issue.

The AMA poll of 1,000 Americans revealed that 98 percent of respondents over age 65 said the anticipated drop in Medicare reimbursement was a “serious problem.” And 95 percent of seniors polled said that “Congress should act immediately.” The poll was taken two weeks ago. AMA President Wilson said, “Congress should take its marching orders from the American public before leaving for Thanksgiving break....Clearly physicians are grappling with a difficult decision, Wilson added. Can they continue to take Medicare patients if Congress allows a 26 percent cut to go through?”

In a news release, the AMA said: “Public concern about the impact in the cut on seniors is valid. Already one in five physicians say they have been forced to limit the number of Medicare patients in their practice because of the ongoing threat of cuts and the fact that the Medicare payment rates were already too low.”

Wilson added: “Without physicians, there is no care in Medicare. The roller coaster ride caused by Congress’ inability to stop the cut [for doctors] for at least a year is eroding physicians’ confidence and commitment to Medicare—right during Medicare’s open enrollment season for physicians. [Patients also can change health care plan coverage if they choose to from Nov. 15 until year end.]

There is growing concern that Medicare is becoming an unreliable payer. Congress must allay that fear by stopping the cut for at least 13 months, which will provide time to begin working on a permanent solution in the new year.”

The doctor payment trouble actually dates back to 1997. That’s when Congress passed a balanced budget law that put the payment formula in place. The notion then was that if doctors cost the Medicare system too much, their pay would be docked in future years to make up the difference. From the doctors’ viewpoint it’s not hard to see why they’re getting more reluctant to take on new Medicare patients, a NPR story last May pointed out.

“We haven’t had a raise in seven years,” said Joseph Stubbs, the immediate past president of the American College of Physicians, which represents about 100,000 internists.

The Obama Administration Nov. 8 expressed support for legislation that would postpone for 13 months the scheduled cuts to Medicare reimbursements. The AMA has previously reported that one in five doctors were limiting the number of Medicare patients  they would treat because of reimbursement uncertainties. The organization also urged Congress to pass the legislation and to include a 1 percent increase in doctor reimbursements.

The 13-month fix would cost an estimated $17 to $20 billion, CQ HealthBeat reported Nov. 9. It added that Senate aides thought lawmakers’ hesitation on budget offsets to the expenditure makes passage of the 13-month fix by Thanksgiving unlikely.

This spring when Congress was working to cobble together the massive health care entitlement, the only way its cost could come near what Obama sought was to leave out the doc fix. But what’s a little crooked bookkeeping among politicians?

Democrat leaders struggled in June to put together a stand-alone doc fix bill to last for six months. Both chambers passed bills. But Nancy Pelosi decided she didn’t like the Senate version. So, a bill finally was passed for a six month reprieve until November.

“There’s a growing lack of confidence in [government’s] ability to deliver on promises to Medicare patients,” charged Robert Doherty, senior vice president for government affairs for the American College of Physicians. There’s a lot of finger pointing going on, but “physicians trying to deliver the best care possible don’t care who’s at fault.”

A hypocritical AARP, which went against the will of seniors and joined in the battle to enact ObamaCare, joined the AMA in an advertisement in January urging the Senate to mend the flawed physician-payment formula. Since AARP’s support of the health law, many seniors have cut up their membership cards.

Forty million American households have Medicare recipients. The Department of Health and Human Services (HHS), in its annual book explaining and promoting Medicare said the Obamacare law is full of “exciting new changes to improve your health care now and in the future.”

But Medicare will have a dismal future if there aren’t enough doctors to treat the tide of older baby-boom Americans sweeping toward the long-promised arms of Medicare.