Congress grants Medicare reprieve Move repeals cuts in physicians' reimbursement

By Liv Osby

losby@greenvillenews.com

Physicians got a reprieve from a 21 percent cut in their Medicare reimbursement this week when Congress voted to repeal it and even gave them a 2.2 percent pay raise.

But it's only a six-month fix. Congress will have to deal with it again in November.

And doctors say it's that instability and uncertainty, along with a payment rate that was until now at the 2001 level, that's forcing some of them to stop taking Medicare patients, or limit the number they take, resulting in access problems for seniors.

"Delaying the problem is not a solution," said Dr. Cecil B. Wilson, president of the American Medical Association. "It doesn't solve the Medicare mess Congress has created with a long series of short-term Medicare patches over the last decade - including four to avert the 2010 cut alone."

The current payment formula was part of the Balanced Budget Act of 1997, which set growth rates that were too low, according to the AMA. Though it resulted in reimbursement cuts, most have been averted by Congress over the years.

It's a perpetual dilemma for the state's doctors, who must balance their overhead costs against their reimbursements, said Dr. Gregory Tarasidis, president of the South Carolina Medical Association.

"Nobody wants to leave patients stranded," he said. "But at the same time, we have to approach this from the small business side of things."

Few problems in S.C.

The AMA says about one in four Medicare patients has trouble finding a new primary care physician and about one in five doctors is limiting Medicare patients.

But in South Carolina, 97.1 percent of doctors accept Medicare patients, up from 94.2 percent in 2006, according to Palmetto GBA, the third-party administrator for Medicare Part B. There is no data on whether any of those doctors limits the number of Medicare patients they take.

In its March report to Congress, the independent Medicare Payment Advisory Commission, or MedPAC, said that nationally, access is generally as good or better for Medicare beneficiaries as it is for privately insured people 50 to 64.

MedPAC reported that in 2009, most beneficiaries have reliable access to physicians, "with most reporting few or no access problems," though finding a primary care doctor was harder than finding a specialist.

"Of the 6 percent of Medicare beneficiaries who looked for a new primary care physician in 2009, 22 percent reported problems finding one - 10 percent characterized the problem as small and 12 percent reported it as big," which translates into 2 percent of the total Medicare population, the commission wrote.

MedPAC said that while access is good on a national level, certain regions may have more difficulty because of other factors, such as rapid population growth and doctor shortages.

Teresa Arnold, legislative liaison with AARP South Carolina, said she occasionally hears from members having a hard time finding a doctor. More often, she says, she hears that there aren't enough primary care doctors to begin with.

"Here and there, AARP members call me," Arnold said. "But the overall statistics don't bear out that there is a problem."

However, South Carolina's population 65 and older is expected to grow from 605,660 this year to 866,280 in 2020, according to the state Budget and Control Board. And South Carolina has 15 practicing physicians per 1,000 Medicare beneficiaries compared with the national average of 19, and four of 10 are 50 or older, according to AMA.

Because the cut was restored quickly, it's not likely to have a dramatic impact on access, said Alwyn Cassil of the Center for Studying Health System Change, a nonpartisan health policy research organization in Washington.

To the rescue

"This situation has gone unresolved for almost a decade now and the cavalry has always managed to ride to the rescue," she said. "But I think the physician community is pretty riled up about this. It's not that they're going to drop all Medicare patients, but it might make them think twice about accepting new Medicare patients."

About nine in 10 physicians in 2008 accepted all or most new privately insured patients and three quarters accepted all or most new Medicare patients, according to the center. Group and institutional practices, as well as rural physicians, were more likely to accept all new patients, and primary care physicians were least likely to accept new Medicare patients.

Most problems surface when someone first joins Medicare or moves, or when a physician retires or dies, Cassil said.

Tarasidis said he can't explain the increase in physicians taking Medicare patients in South Carolina, except that there is a big Medicare population in the state so those patients may be a larger part of a doctor's business.

But Cassil said some physicians rely on Medicare patients and can't afford to stop seeing them.

In 2008, physicians got almost half their revenue from the government - 31 percent from Medicare and 17 percent from Medicaid, she said.

MedPAC reports that the Medicare payment in 2008 averaged 78 percent of private insurer payments, a generally stable ratio over the decade ending that year, which saw spending for physician services grow 72 percent.

Originally published by By Liv Osby losby@greenvillenews.com.

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