A guest column by the American Medical Association, exclusive to KevinMD.com.
Unbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare physician payment cut. Senators cut and ran on America’s seniors and their physicians, heading home for the Memorial Day recess before taking action. Now the Senate is back in Washington, but they still have not voted to stop the cut, which began on June 1.
The AMA will not sit silent as the Senate turns its back on our nation’s seniors, military families and the physicians who care for them by failing to stop a 21 percent Medicare cut to physicians before the June 1 deadline. We’re turning up the heat with a multi-million dollar ad campaign focusing attention on the Senate’s failure to stop the Medicare cut in time over Congress’ Memorial Day recess. The TV, radio and print ads encourage the public to contact their Senators and say: Tell your Senators to get back to work and fix Medicare now.
At the AMA’s annual meeting this weekend, physicians will participate in a White Coat Rally – signing their outrage on white coats that will be delivered to congressional offices in Washington.
The Center for Medicare and Medicaid Services (CMS) again put a hold on claims for 10 business days to give the Senate time to vote, but that hold expires on Tuesday, June 15. It’s unclear if the Senate will meet that deadline as well. And frankly, this hold is just a minor stop-gap measure. The uncertainty is already taking its toll. Physicians are frustrated and they are making practice changes.
Our new online survey of 9,000 physicians who care for Medicare patients finds that seniors are already being hurt by Congress’ mismanagement of the Medicare program. About one in five physicians say they are already limiting the number of Medicare patients in their practice. In primary care the numbers are even worse, with nearly one-third of primary care physicians already forced to limit the number of Medicare patients they can treat. The top two reasons physicians gave for having to limit the number of Medicare patients is the ongoing threat of future cuts and low Medicare payment rates.
Last week, the AMA held a news conference on this crisis and I shared the following true story: The day before the news conference, the AMA received a call from Joan, a retired nurse. She was looking for a physician in Maryland for her 72 year-old sister and could not find one that took Medicare. Both physician offices she called said that as of this June 1 they were no longer accepting new Medicare patients.
I’m sure Joan’s experience is not unique, and it jibes with what we found in our new survey. In response to this year’s two previous short-term delays to the 21% Medicare physician payment cut, nearly two-thirds of physicians looked into opting out of Medicare and treating patients through the private contracting option. Physicians also: delayed payments for supplies, rent and/or other expenses (39%), took out a loan or line of credit in order to continue paying bills (17%), held up paychecks or laid off/furloughed staff (17%), cancelled or postponed scheduled services to Medicare patients (14%) and temporarily closed practice to new appointments with Medicare patients (13%).
Medicare payment rates are already far below the cost of providing medical care. In fact, payments are about where they were in 2001 while costs are up over 20 percent. Congress cannot expect physicians to adopt health information technology, engage in quality improvement and care coordination initiatives with payments far below the cost of providing medical care. It costs a physician anywhere from $30,000 – $44,000 to purchase and implement an electronic medical records (EMR) system. Ongoing costs to keep the system up and running are about $8,500 annually.
Everyone recognizes that the formula Medicare uses to calculate physician payments is hopelessly broken and in need of repeal. The temporary band-aids that Congress has grown accustomed to applying to this issue have grown the problem. The cost of a temporary solution now significantly exceeds what it would have cost to implement a permanent solution just a few years ago. Today, we are dealing with a 21 percent cut, and the bill passed only y the House that delays the cut 19 months would result in a 33 percent cut in 2012.
President Obama, Republicans and Democrats in Congress, MedPAC and other health policy experts have all said the current payment system is broken. In fact, President Obama repeated the need for a permanent fix and quick action to stop this year’s cut at a town hall event with seniors earlier this week. We will keep up the pressure on Congress until the Medicare physician payment problem is fixed once and for all so that dedicated physicians can continue to care for seniors now and well into the future.
J. James Rohack is President of the American Medical Association.
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{ 14 comments }
Part of me WANTS to see the cut happen.
Maybe it will finally lance the boil when people find they can’t access healthcare, or find all the docs went nonpar or opted out.
Our only recourse is to opt out of medicare/medicaid altogether. If enough doctors do it then it will force change to happen.
The AMA (of which I am a member) destroyed its crediblity in order to support ObamaCare, with the assurance that the yearly ritual of Medicare fee reductions would come to an end.
Like everyone else in America, we were utterly and massively lied to.
No wonder 60% of Americans want the Obama plan repealed.
And I love the preposterous Medicare propaganda sent to all beneficiaries last week. You know, the one that begins:
“The Affordable Care Act passed by Congress and signed by President Obama this year will provide you and your family greater savings and increased quality health care.”
The government will just mandate that Doctors have to accept medicare to be licensed: See Massachussettes
You’re right, Shah, and that’s the scary slippery slope of declining reimbursement, now starting to be tagged to things such as “accepting Medicare” and “maintenance of certification.”
This rhetoric that all physicians will “opt out” simply is not true. It would be like suicide to opt out of Medicare. Until balance billing is in place, this would be a bad move. To send a message without breaking the bank, the better thing is to go non-participating and you can still see those patients who can’t afford to pay the extra fees and accept assignment. We have to be above the fold and if patients see us as greedy then it will backfire. From comments on other blogs, and from impressions of politicians’ comments, many patients and politicians (erroneously) think that we make 1 Million + per year. As a family physician I can assure them that it is not nearly that much, it is just as much as any other small business professional including plumbers, electricians, auto mechanics, etc. and not nearly as much as lawyers, politicians, etc.. In that way we are a “trade” and we have to protect our profession. The AMA sold us out and that is why I quit the AMA. Now it is possible that congress will never really pass a permanent fix because the deal is done and there’s really no political will left to do as much. The AMA does represent the majority of physicians and my primary care specialty society (AAFP) has failed me also. I think we should let the politicians do their thing, and I appreciate the AMA’s campaign to finally pressure lawmakers. But it is as always, too little, and too late. It would have been better to do this a year ago.
Dr. Rohack, how’s that AMA strategy working for you? And why is AMA bleeding members?
People need to see past “doctors pay” in these discussions. Whenever I read comments/articles about the SGR, health care reform, declining reimbursements, etc., many people tend to respond with indignation that doctors could ever deign to decline to treat our grandparents. The sad part is that people usually are intently aware of their own financial situation but couldn’t care less about the plight of others, unless it adversely affects them.
Sorry to sound so cynical. Usually I try to keep my optimistic self in check. I think that the solution to all of this would have been a health care reform package that somehow did not cater to the insurance companies and that included liability reform.
When we have real improvements in the form of insurance portability, which may create competitive premium pricing, then perhaps we will see a change in the way insurance companies do business.
Barring that, ALL physicians would need to magically come together and voice their objection to the government’s meddling in the pricing of health care.
I would like to see some sort of fix before I reach Medicare age, myself!
I guess snuggling up to the Obamaminions at the Congressional kiddie table didn’t work so well for the rank & file, eh?
Yes patients don’t care about doctors salaries
Yes it’s fiscally impractical for most specialists to opt out
BUT Dr. Shah hit the nail on the head. American doctors will loose ALL control when they tie our licensing power (like Mass is trying) or our prescribing power (see obamacare that only allows Medicare accepting physicians to write for wheelchairs). Rohack needs
to stop acting after the fact. No other lobbying group would have given up so much.
I agree with those commentors that say the AMA brought this on. By making a deal with the Administration, they thought to gain a solution to SGR.
But all the revenue and savings went to support the massive health care overhaul, and the fix had to be shuffled aside.
Also, as was recently reported, the AMA makes most of its money from their copyright of the CPT coding system. According the National Review blog, AMA reports revenue of $268M, $210M from publishing…mainly the CPT code. That they want to sustain a CPT-based cost-plus system is not surprising.
Nobody cares about the cut except physicians. Especially not patients
The only way patients will care is if you cut them off
Drop out of Medicare en mass.
That is the only effective means to this political end
“Drop out of Medicare en mass.”
Will never happen.
What I believe is hapening is the slow death of Medicare by a million pinpricks. By this I mean, slowly reduced access as physicians limit their Medicare practices to fewer and fewerf easy cases.
If you are really, really sick in the near future, good luck trying to find anyone decent to follow you as a patient. Obama’s $500 billion cut in Medicare will devastate acute care.
As an extra unintended negative consequence, the top specialists are already shutting their doors to new Medicare cases. You soon will no longer see any of the best doctors.
In any case the Baby Boomers are in for a colossal shock as they are forced against their wills into Medicare.
If this problem isn’t fixed, and the 21.5% cut goes through, Medicare will experience a failure event that will present differently in different places among different specialties. Busy internists who have long waiting lists will stop new Medicare accessions and some will completely withdraw from the program. Smaller numbers will go boutique and drop all third-party payment, with or without membership fees. Those doctors will be able to greatly streamline their practices and reduce their operating overhead costs. With the withdrawal from Medicare goes any outside impetus to comply with federal laws mandating EMRs. In fact, most mandates lose their force once one no longer takes federal money.
Some practices won’t have any viable option and will close. Not every practice can stay open with a cut that halves or worse the income of the doctors. When you stop paying a living wage, or even a competitive wage, people quit. Even owners quit. Contrary to what some people think, doctors will not continue to serve Medicare beneficiaries regardless of the payment the program provides.
The Tricare military beneficiary and retiree program will also go to the weeds, and fast.
If you end up losing money either way, seeing patients or not, you can’t count on “professionalism” or other notion of duty to expect doctors to continue working. Practices are like other businesses and when they don’t run in the black, they’re done. If they can’t make their practice run without Medicare, on whatever terms of payment they can devise, they fold.
And to Solo Family Doctor MD: suicide or murder, at the end of the day, what is the difference? Not viable, as in a business that can’t pay its key employee, the doctor, is just another failed business. We aren’t special, at least not special enough to be able to avoid the general rules of any private business, and most of us aren’t living on trust funds that we can afford to work without earning an income.
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