AMA: Patients and physicians call on Congress to stop Medicare cut

A guest column by the American Medical Association, exclusive to

Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.

The AMA is working on behalf of physicians and their patients to urge Congress to take action before Thanksgiving to stop the cut through the end of 2011.  We are calling for a 13-month delay to help stabilize the situation and allow time for the new Congress to enact a permanent fix to the perennial problem of the Medicare physician payment system.  Congress must act this month – the first cut, a whopping 23 percent reduction, is scheduled to occur on December 1.

Due to the critical need for congressional action before Thanksgiving, AMA is helping physicians make their concerns heard in the nation’s capitol.  Contact your elected officials in Washington, D.C. and let them know that you support an immediate 13-month stop to the Medicare physician payment cuts, and permanent reform going forward.  Physician support is especially necessary on November 17th, “White Coat Wednesday”, when physicians across the country will join together in calling their members of Congress to urge them to stop the cut.   The Physicians Grassroots Network hotline is available at (800) 833-6354, and provides individual physicians the resources they need to contact their elected officials about how this cut would impact their medical practice.  A new flyer is available free to physicians to display in their office to educate their patients about the scheduled cut and encourage them to call their elected officials.  We also have resources on our web site to help physicians decide their Medicare participation status for next year.

There is a resounding call from across the country for Congress to take swift action.  A brand new AMA poll of Americans, released this week, found an overwhelming 94 percent of adults age 18 and over feel the looming Medicare physician payment cut poses a serious problem for seniors who rely on Medicare.  Four out of five adults said Congress should act immediately to stop the Medicare physician payment cut.

Cracks in the system are already showing, and it is critical that Congress stop the cut this month before more seniors are hurt by Congress’ continued Medicare mismanagement. About 1 in 5 physicians overall, and nearly one third of primary care physicians, are restricting the number of Medicare patients in their practice because of low reimbursement rates and the threat of future cuts, according to an AMA survey earlier this year.

Patients are concerned about this 25 percent cut, and they can make their voice heard in Congress through our Patients Action Network.  AMA’s new national ad encourages patients to contact their members of Congress by calling 888-434-6200.  Leading organizations, including AARP and the Military Officers Association of America (MOAA), are calling for Congress to stop the cut.  Today is Veteran’s Day, and with MOAA, we are drawing attention to the fact that the nearly 10 million military families who rely on TRICARE also face a crisis in access to care, as TRICARE ties its physician payment rates to Medicare.  In fact, MOAA has called these payment cuts the number one threat to military beneficiaries’ health care access.

The united call for action on the scheduled 25 percent Medicare physician payment is coming from patients, physicians and military families across our nation.   It is supported by the vast majority of American adults.  This month is the time for Congress to answer that resounding call by taking action to stop the cuts – before it is too late.

Cecil B. Wilson is President of the American Medical Association.

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  • cindy sanford

    When are we going to get it that the party is over for the United States and across the board cuts are needed in every spending program? If we keep pushing the payday down the road and fool ourselves into thinking there will be no pain in getting the U.S. back into solvency, our ultimate day of reckoning will be far more painful.

    • Vox Rusticus

      I will drop all objection to imposing the SGR on three conditions: first, allow balance billing, second, remove all upper limiting rate limits to charges and three, permit medicare participating physicians to selectively accept assignment by procedure/CPT code provided an ABN is given to the beneficiary explaining the costs of items for which the physician does not accept assignment.

      Fairness and viability, is that too much to ask?

  • Paul Dorio, MD

    Thank you Dr Wilson.
    Everyone must understand that the SGR and its potential reimbursement cuts affect all of us, not just doctors. Everyday I listen to doctors under stress because they are forced to close their doors to new Medicare patients. It is leading to an even worse access to care crisis. With enough discussion by both medical and non-medical people, hopefully the Congress will finally enact a permanent fix to the flawed SGR, thereby allowing us physicians to do what we want to do: continue caring for our aging and ailing patients.

  • Max

    AMA supported the healthcare reform bill. I say drop physician payment 40% across the board. I hope they cut it even more.

    • Vox Rusticus

      That will make it simple Max. No doctor will be taking Medicare because the cost of service will exceed payment.
      That will be widespread failure of Part B. Perhaps that is what you want?

      As for the AMA, I see them as an interest unto themselves, pretending to represent the interests of American doctors when their loyalties are as divided as are their revenues, earning money by inventing and leasing coding information and acting as a back and forth mouthpiece for the government and the CMS and only occasionally for that minority of American physicians who bother to remain members.

      They have embraced confusing missions, pretending to be an organ for patient “advocacy” while becoming less and less effective at physician advocacy and, unfortunately also, better and better at AMA advocacy.

      • Max

        My reply to the article was tongue-in-cheek, Vox. I’m with you. My point was the AMA wanted their cake by supporting this bill, yet they want to stop the rate cut? The whole premise of the bill saving money, as born out by later examination, was that the cuts were necessary to actually ‘save’ money. When the cuts are removed, the bill the AMA supports actually loses money. They can’t have it both ways. If I could, I would say every physician who belongs to the AMA has their Medicare payment cut 50% or more.

  • imdoc

    I advocate to permit the reimbursement cuts to proceed in trade for unlimited balance billing. That way docs can once again set a price. Medicare patients will pay more to doctors if they feel it is worthwhile and they are likelier to question value of expensive tests and procedures. For truly needy elderly, I think many doctors would accept the reduced schedule and not pursue additional payment. All Medicare beneficiaries would still receive some subsidy. Without some kind of change, the long term outlook for the Medicare program is continued crisis

  • cindy sanford

    Medicare cuts will hurt me too. I am a home health nurse and have already seen a drop off in the amount of visits we are permitted and referrals we are getting. That has hurt my income and I make a LOT less than MDs.

    But my conscience will not permit me to pass the mess we are now in onto my children. The bottom line is: there are no longer any painless solutions for anyone. We got ourselves into this mess and I for one, am not punting it to my kids.
    It’s time for America to grow up and accept that there will be some lean years for all of us— unless we want to entirely exempt the next generation from the American dream.

  • residentdoctor

    balance billing is the answer to the question. It is so easy. This would actually put a small amount of free market back into healthcare and save the government system at the same time.

    It makes so much sense it is scary that no one else is saying it. BRING IT BACK.


    Balance billing is a wonderful option if it is sympatico with what is needed….

    Balance collections. A policy sign will be needed at checkout similar to my dentist’s office that reads, “payment is due at time of service unless prior arrangements have been made…we accept MC, AE, cash or check”.

    • Vox Rusticus

      I have had that on my front desk since I opened.

  • Doc99

    It’s not just Medicare payments that will be cut. Tricare payments will be cut as well. Tricare has been colloquially referred to as “Try and Get Care.” If anyone deserves so-called Cadillac insurance, it’s our troop, our veterans, and their families. Hey, I’ve got it. Let’s have Tricare cover Congress instead and give our troops and their families the coverage Congress presently enjoys. Works for me.

  • A. House

    The majority of people are working class low to moderate income. Medicare and Social Security are safety nets for survival and medical care – both resources have allowed individuals to continue working and contributing to their families and country with FICA taxes that they put faithfully into the system. They have paid for this health benefit with their labor and sweat. It is not an entitlement, they invested and earned the right to this “safety net” from being beggars in the street as their forefathers did, before Social Security and Medicare. These recipients too have been victims of a society of “unregulated” GREED – Corporations sending our jobs to people over seas – reduced our taxes into the FICA system; the manufacturing overseas – reduced our skilled labor force; the IRAQ war has caused endless spending and created more enemies. Banks and financial institutions with CEO’s (private industry) etc with fraudulent schemes and strategies — all have bled the working class. Is it your fault – the Doctors – who are looked upon as “special, and respected” ? No, nor should you be a victim of less reimbursement or even an idea of cuts. Those actions need to be stopped and not even placed on the table. Other revenue sources and financial leaking must be addressed and stopped; such as: STOP THE OUTSOURCING of our jobs and get our people back to working. WHY ISN’T THEIR AN OUTCRY FOR THAT? DOCTORS, I do hear your concerns – and I do agree with your concerns, but, I hear your sarcasims too; — BALANCE BILLING IS NOT THE ANSWER! You cannot get blood from a stone; yes, you can put up the sign and say, cash now, or you can bill patients above the payment of Medicare; but actually receiving this additional payment from people just barely making a living will prove quite difficult, with lots of anguish. You can turn them away for those who can pay — but how many are there? Eventually, you will tap the same circle, eventually, it runs dry. The greater majority of people count their pennies. A great majority on original Medicare have gone bankrupt. Medicare Advantage was designed to help people get medicare care without going bankrupt and allow people to take care of their health needs. Those persons under 65 – most of them do not have health insurance and they go to emergency rooms ($2,000 utility). Most, cannot afford major medical health insurance. I say all this, because your anger clouds your realisim. Are all of you targeting the wealthy? If so, then what about the masses of people who cannot afford your services, who cannot pay unexpected balance billing – how do you really win? Do you turn them all away, and wait for the goose with the golden eggs? How much cour litigation and collectors are you willing to pay and hire? It appears, all the physicians who have commented in this column sounds bitter and vindictive — I hope you will look for wiser realistic solutions and realize we are all casualties of on-going borrowing from Soc. Sec – and never paying it back; an on-going support of an Iraq war and Afganistan war; and an eroding tax base due to unemployment; why don’t we come together as a nation and scream STOP THE WAR, PULL OUT NOW, THE COST IS TOO MUCH TO BEAR! — Our sober thoughts must be solutions that recognize our collective interdependence and that what chronically hurts a few will have an insipient domino effect upon others and the nation. Please do not let greed, self-interest and dark thoughts pollute you and your honorable profession, we are all hurting. Let’s look at this nation’s challenge with an eye of togetherness.

  • Paul Dorio

    Very insightful and interesting perspective, House. I agree that balance billing would not be a great solution. As I said originally, there needs to be a permanent fix to the SGR and soon. The constant yo-yo discussion surrounding that issue is tiresome and scary with uncertainty. Sort of like the current economy with banks being unable to lend and businesses unable to hire due to uncertainties regarding taxes.

    It is imperative that we all work together to voice our displeasure at continued reimbursement cuts and increasing constraints on best medical care. Government regulators and decision-makers must realize that attempting to control healthcare costs by cutting reimbursements will hurt patients.

    Self-referral must be eliminated. Insurance must be made portable to allow market forces to constrain premiums. Medical liability reform (patient compensation funds and caps on punitive damages) must be enacted. Then we may see improvements in care and costs across the board.

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