Fixing Medicare Reimbursement
Physicians dodged another bullet this year as Congress overrode the president's veto of legislation to block the scheduled 10.6 percent cut in physician reimbursement in the Medicare program. With the Sustainable Growth Rate (SGR) formula as law, similar cuts have been scheduled every year for several years, and each time a frenzy of activity from organized medicine has been able to prevent the cuts from being enacted. How long will we go on like this before meaningful reform in Medicare reimbursement takes place?
We Americans spend about twice as much for healthcare as other similar countries, yet physicians in private practice are paid at rates that are not sustainable to a medical practice. This paradox has many causes, including excessive money spent for administration, profit-taking by health plans, and many imbalances in the reimbursement schedules to favor gadgets over real care. As I watch the Scooter Store commercials, or the ones for pulmonary and diabetic supplies, I wonder how much profit is built into these companies that have a direct line into Medicare funds - certainly enough to pay for prime time national television marketing!
I am a registered Democrat hungry for a new administration in Washington that places the care of people over the profits of corporations. Whether Democrat or Republican, the members of the San Diego County Medical Society unite for the welfare of patients and the physicians who care for them. On the eve of sending the Medicare legislation to the president, the following letter was sent electronically to the White House by past SDCMS president and CMA trustee Ted Mazer:
Dear Mr. President,
The time is late for suggesting that some other means for avoiding the draconian cuts to Medicare physician reimbursement should not come from overpaid private insurers, as the entire Medicare access system is ready to implode. I am a Republican physician (although these days I find it hard to defend the Republican positions on healthcare financing) practicing in San Diego, California, an area that CMS and Congress still consider to be rural under the Geographic Practice Cost Index (GPCI) portion of the Medicare RBRVS payment system. After 20 years of practice, I find it intolerable that we have faced cuts year after year under an acknowledged broken calculation system, only to be told that we are 'saved' each year when rates are held flat.
In the meantime, Medicare Advantage PFFS programs are being paid 112-119 percent more per patient than is allotted in the standard Medicare program. Yet the White House feels that the taxpayer should continue to overpay these programs for their 'add-on' services, while private physicians lose the viability of their practices in the ever-shrinking payment by Medicare and these same private MA programs. Yes, the private payers profit at the expense of the taxpayer, but those monies are not passed on to the providers of actual care, and, simultaneously, Medicare pays the providers less and less in real dollars every year. If the private sector insurers can offer Medicare beneficiaries the same, better, or more services AT THE SAME COST AS THE REGULAR PROGRAM TO THE TAXPAYER, then by all means I support such an approach to privatization of Medicare. But such is not the case in the current MA PFFS programs!
In San Diego County it is even worse, with Medicare underpaying the doctors for fee-for-service (FFS) Medicare over $30 million a year, despite recognizing the unfairness of the GPCI calculations.
As a loyal Republican, and as a practicing physician, I implore you to get past the politics and the showdown mentality, and address the pending collapse of access to care in the Medicare program by signing the current legislation and moving for future corrections to the entire flawed payment system as soon as possible. I have already closed my practice to new California Medicaid (Medi-Cal) patients as of the first of July due to 10 percent cuts in that already underfunded program. Having served Medi-Cal patients for 20 years, I cannot afford to take any more cuts and pay out of pocket to take care of patients. The same will be true in the Medicare program should the 10.6 percent cuts be allowed to go through. I, and many of my colleagues, will be left with little choice but to cut the number of new Medicare patients we will see, simply in order to maintain the viability of our practices. That serves no one at all!
Ted Mazer, MD
Otolaryngology, Private Practice
Past President, San Diego County Medical Society
Trustee, California Medical Association
Hopefully, this will be the last year that we have to scramble just to keep our heads above water. Medicare does not lack funds, yet it is time that they use them wisely and recognize the physicians that care so well for seniors. With the Baby Boomers entering the Medicare program over the next 20 years, waste and inefficiency can no longer be tolerated. Organized medicine stands ready to work with a new administration to carve out an improved Medicare program that is truly sustainable year after year.