Texas Medical Association: Stop the Medicare meltdown

A guest column by the Texas Medical Association, exclusive to KevinMD.com.

by William H. Fleming III, MD

So we have this new health law that’s intended to provide better health care access for most Americans. Many of the reforms rely upon the sustainability and effectiveness of Medicare.

Medicare, however, is doomed to failure unless Congress fixes a fundamental problem existing within the current program — the Sustainable Growth Rate (SGR) formula. The new health law ignored it. Now Congress and the Centers for Medicare & Medicaid Services (CMS) are sending physicians and patients on a daunting roller coaster ride — with no end in sight.

Medicare Roller Coaster Ride

For the past decade, physicians have had to live with the uncertainty of a potential Medicare cut. However, nothing has topped the gut-wrenching events of the past four months. Four times since Jan. 1 physicians have waited and worried about a Medicare payment cut. First came the potential cut of more than 21 percent starting Jan. 1. Congress postponed it until March 1. Then until April 1, and now through June 1. Twice in the past four months, the steep cuts actually took effect. The March cut lasted one day. The April cut lasted 14. Each time Congress stepped in only to delay the cuts — never to fix the problem. Twice this year, CMS has held payments because of congressional inaction. These constant payment disruptions create an administrative catastrophe for our practices.

The continued uncertainty complicates our ability to make decisions for our practices. Many physicians are postponing equipment purchases or taking on more patients or staff because we simply cannot plan in this environment. Others are opting out of Medicare or choosing not to take any new Medicare patients. Meanwhile, senior citizens, people with disabilities, and military families are left without a doctor of their choice.

It was hard enough on physicians to worry about Medicare cuts year to year — now it’s month to month. We are frustrated, worried, and not sure what the future holds for our patients or our practices. We are the foundation of any health care system. The government simply cannot build a new health care system if the foundation of Medicare is crumbling.

Stop the Medicare Meltdown Petition Drive

That’s why a nationwide petition drive is underway, spearheaded by the Texas Medical Association. Fifty other state medical societies and more than 30 national and state specialty medical societies have joined to gather 1 million signatures. The goal is impress upon Congress the SGR issue is real and it’s a local issue — affecting every one of their constituents. Medicare patients are not pawns for use in a political chess game. What Congress decides to do or not do about the SGR affects every patient, in every state. Congress must address the Medicare Meltdown now. Physicians and patients across the country are demanding a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.

Please join the petition drive.

Add your name to the Stop the Medicare Meltdown petition.

William H. Fleming III is President of the Texas Medical Association.

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  • http://www.MDiTV.com Aurora

    This is realy interesting to read, thanks for posting it. This is the first time I have heard about the medicare issue from a collection of doctors. I’m curious to hear what is the ultimate goal of the petition drive. Are there solutions that the Texas Medical Assoc. has in mind?

  • http://texmed.org Pam Udall

    Act today and sign the Stop the Medicare Meltdown petition: http://www.ipetitions.com/petition/meltdown/
    Join patients and physcians across the United State to save Medicare.

  • rezmed09

    Great question Aurora.

    Yes, what exactly does the Texas Medical Assoc want done? What solutions are you putting forward? Surely any suggestion will be robustly criticized as either – Tax and spend, rationing and heartless, giving in to greedy doctors, or more government interference. Of course the old fall back for every politico in DC is a series of reforms that “reduce waste and fraud” (like that ever works) or a system of cost controls that are so confusing, that HC spending only is reduced because it is such a headache to get it done or paid for.

    Medicare is melting down precisely because there is agreement on the best way to fix Medicare and get reelected.

    • rezmed09

      Medicare is melting down precisely because there is NO agreement on the best way to fix Medicare and get reelected.


    I have already signed. My state medical society is currently voting on whether or not to support it. Should have an answer soon.

    I am confused by the math of “state medical societies” that have signed on. You state that “50 other state medical societies have signed on.” To my knowledge, there are only 50 states in the country and my state, New Hampshire, is still voting on it???

    Are you including non state societies? Puerto Rico?

    • http://www.texmed.org Steve Levine

      Paul, MD: As of time this was written, all 49 other state medical societies plus the District of Columbia society had signed on. That may have been a decision by the president, board, executive committee, etc… but we have documentation covering all 50 (plus Texas, of course, which makes 51 … or “50 other”)

  • Matt

    If all you’re doing is going to the government and asking them for more money, you’re fighting a losing battle. There is no more money.

    Why physicians continue to believe their salaries will never and should never decline regardless of economic conditions is a mystery to me.

  • Steven Wynn


    Actually, physician dollars have been shrinking in real dollars for more than a decade. The pot of money allocated to pay physician fees has not kept up with inflation. Sure, physician salaries don’t necessarily go down in inflated dollars, but how would you like not getting a raise after a decade of work?

  • Matt

    At a minimum I’d start looking for a new payment model rather than continuing to beg for more from an entity looking to cut costs. Especially if that entity was a government well aware that I get paid nearly twice than my colleagues around the world.

    • MS1

      Most of the rest of the developed world has free medical and undergraduate education for doctors, higher pay during residency, and much lower working hours for physicians during and after residency. It is not apples to apples. I have classmates who will have more than 400k in undergraduate + medical school debt upon graduation and a minimum of 3 years at a low wage afterwards where at best they can do is pay the interest, meaning that the total lifetime cost of their educational debt is well over half a million dollars. Something has to give, increasing tuition costs and declining reimbursement can only last so long before nobody in their right mind would apply to medical school . It is already driving many of our best and brightest to pursue other fields.

  • hawk


    I would like to propose a solution, I would be willing to work for an hourly rate, but YOU must do the same. All lawyers should be paid based on a government determined fixed rate hourly fee. This would hopefully solve the malpractice problem as well, since there would be less jackals trying for the jackpot jury.

    I know you will post a completely irrelevant comment about this, so please do try and stay on topic.

  • Matt

    I do work for an hourly rate, although at times I do contingency work and at times flat fee work. That’s the freedom I have, which you could as well. I don’t rely on the government for payment, so it doesn’t get to dictate the terms. YOU chose to contract with the govt, so you play by its rules.

    You could do the same as me, but your profession for the most part has chosen to stick with the third party payment system. Understandable, since your profession makes on average 50% more than mine, and about 75% more than your colleagues around the world. But none of that makes YOU have to sign those agreements to be paid that way.

    You’re looking to me for a solution, but that’s the same mistake the TMA is making. Look to YOURSELF. Take control of your practice. Did you really become a professional just to give up all your autonomy for a few more dollars?

    As to solving the malpractice “problem”, changing how I get paid won’t make your profession commit less malpractice. That’s again on YOU, not others. Only about 1 in every 8 instances of malpractice result in a claim, so it seems that the only “problem” is there is too much malpractice.

    • http://www.kevinmd.com Kevin

      “Your profession makes on average 50% more than mine, and about 75% more than your colleagues around the world.”

      I see this mentioned repeatedly. In the future, please qualify it by i) comparing the cost of medical education and malpractice insurance of the American physician with the rest of the world; and, ii) comparing the salary of an American attorney with the rest of the world. I’d appreciate it.


      • Matt

        I mention those numbers not because I think you don’t deserve them, but to point out yet another factor the government will be looking at when it starts looking for savings. I have no problem with physicians getting paid whatever they can. If your skills are worth X, then I fully support your ability to get X.

        As to the cost of medical education on average in each country, where might I find that number? Not sure what the relevance of what attorneys make compared to the rest of the world is, since they don’t go to the government (except for those that are specifically govt. employees) for their income. Thus their pay is privately contracted.

        However, I will gladly mention those if you can provide me the numbers. I would only ask that when you are lamenting the costs of malpractice claims and the amount of them compared to the rest of the world, you will qualify it with the statement that the countries you are comparing to typically have universal healthcare, which eliminates much of the need to pursue a malpractice claim as the victim is often uninsurable in the US. In the interest of full disclosure and all. I’d appreciate it.

        However, at the end of the day, the point doesn’t change. You guys are begging the government for more, when it’s quite clear that there isn’t much more, and the government is looking to reduce these costs, not increase them. Rather than try and keep a sinking ship afloat, perhaps you should be focused on building a new boat.

        • http://www.kevinmd.com Kevin

          As you requested, here are some numbers for future reference when bringing up physician salaries.

          US medical school, average one year tuition (4-year):
          $42,906 ($171,625)

          Canada medical school, one year tuition (4-year):
          $12,728 ($50,912)

          France medical school, one year tuition (4-year):
          free (free)
          “medical school is paid for by the government”

          I trust that you find this information helpful.


          • Matt

            Very helpful, thanks.

          • Primary Care Internist

            You forgot to mention the opportunity cost of at least 4 years of lost income, accruing interest, of maybe $100,000/yr versus law school grads (4th yr med school plus at least 3 yrs of residency).

            Over 30 years this accumulates to almost $2 million at a modest 5%/yr.

          • Matt

            Do you really think the average pay for starting law grads is $100K/yr?

      • BD

        >>i) comparing the cost of medical education and malpractice insurance of the American physician with the rest of the world>>

        Malpractice insurance is a deductible expense, a cost of doing business, no different from the utilities bill. For example, if a physician’s salary is $250K but his malpractice insurance cost $50K, his salary would still be $250K.

        Just to be clear.

        Furthermore, if physicians actually did the math, they’d find it’s far more lucrative over the course of one’s career to pay more for education then enjoy much higher salaries once training is completed vs. incur less debt and live with a lower salary.

        What physicians actually want is: low cost education, high salary for as many years as possible, and no risk of being sued for malpractice. Understandably.

  • Matt

    And, Kevin given your zeal for full disclosure, I hope we also see from you when you talk about the Texas “miracle” of tort reform, where Texas sits in per capita physicians both before and after. Particularly compared to states without such “reform” like New York. I’d appreciate it.

  • http://www.acc.org Dr. Jack Lewin

    Instability, as any doctor will tell you, is never a good thing. Yet, Congress’ failure to permanently address the flawed SGR formula is creating precisely that – dangerous instability in our health care system. Washington’s ongoing string of band-aid solutions – the next of which will be yanked off June 1st – are placing a severe strain on doctors, their practices and Medicare patients.

    The American College of Cardiology was proud to be the first specialty group to sign the Medicare Meltdown Petition, and we encourage the entire medical community to add their names to this growing list. Either way, the ACC will keep fighting until we get a payment system that places an increased focus on evidence-based medicine and quality of care improvements. Out patients deserve nothing less.

  • imdoc

    Matt – I TOTALLY agree we need a new deal and doctors need to get away from being supplicants to a government program, but how? Have you ever operated in a business model in which the market is divided up into those with public entitlement and the balance controlled by a legal monopsony? Considering that doctors cannot unionize or collectivize how does one penetrate this?

  • BILL

    The Medicare cuts which are now at 21% are schedule to continue to increase by 5% a year and eventually reach 40%. My present Medicare reimbursement(before any of these cuts) for a neurological evaluation in exactly the same in real dollars(not inflation adjusted) as it was when I entered practice in 1978. In 1978 I ran my practice with 2 employees whereas today 5 are required. All other practice expenses have gone up with the inflation rate. It is obvious that the proposed Medicare cuts make no economic sense at all. The government is simply trying to cover up the fact that all the money that Medicare beneficiaries have paid in over the decades has been spent on…who knows what.

  • Tony Palmer, M.D.

    How many times must we contact our representatives in Washington to fix the SGR formula? Again,we are now one month away from the 21.5% cut. Will these temporary fixes be monthly events? Perhaps it would be better for the cut to take effect and experience what fallout, if any. will occur? Will physicians take these cuts and keep enabling the government or will we act? Ultimately, as single-payer government controlled health care inevitably results, physicians should insist that we become government employees.

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