Doctors Pulled From the Brink of a 25% Cut in Medicare Payments

Those lame ducks continued to flap their wings and fly high with another major December achievement. With no media attention or ballyhooing from the Dems, the Medicare and Medicaid Extenders Act (HR 4994) was passed and signed into law by the President on December 15th. This legislation provides a one-year reprieve from a 25% reduction in Medicare payments of doctors' fees that would have otherwise kicked in on January 1, 2011 (although the name of the bill includes Medicaid, no such cuts in that program were included; instead, the bill actually provides for an expansion of some of its programs). An earlier proposed cut of 23% had already been scheduled for December 1. Fortunately, Congress took action in late November to thwart this bloodletting, at least in the short-term.

Such a draconian cut to Medicare payments would surely have resulted in a massive withdrawal of doctors from the program, a significant blow to its health and survival. Doctors stopping their treatment of patients - or suddenly asking for direct payment to continue their services - would have been devastating for the elderly, ill and most vulnerable among us. One can only imagine what would have happened had this bill not passed during the lame duck session, before the conservative/Tea Party takeover of the House. Their cry would have been, "The deficit, the deficit!" and their cheering would have been deafening as their decades-old dream of ending one of our most successful entitlements came ever-closer to realization. We must be ever vigilant in protecting these programs, and Dems must start fighting to prevent similar cuts from occurring next year when this extension ends. Otherwise, 43 million seniors and disabled, along with hundreds of thousands of doctors, will be severely impacted.

The key to this issue is the Sustainable Growth Rate (SGR), a complex formula dating to the 90's used to calculate doctors' payments. The senior New York Dem on the House Energy and Commerce's Subcommittee on Health, Rep. Eliot Engel (NY 17th), will have a one-year opportunity to discuss and influence this process in this Committee. Of course, he should expect rough sledding in the 112th Congress, but he must take up the fight, if for no other reason than to help his fellow Dems heading into the 2012 elections; Medicare and Social Security can be winning issues for Dems, if they come out strong in defense of these programs over the next two years.

As doctors' payments are discussed in Committee - along with a new formula for determining those fees - consideration must be given to an increase in payments for Primary Care Physicians (PCP). They are at the low end of the payment scale and are on the day-to-day front line of preventive medicine, acting as our gatekeepers and referring us to specialists when needed. A PCP is a diagnostician, tasked with spotting tell tale symptoms before they develop into a full-blown illness. These doctors have as many as 3,000 patient-visits a year, usually in large urban areas, and often are working in their offices until 10 p.m. plowing through mountains of paperwork. Overworked and underpaid, they are forced to spend less and less time with each patient.

How about offering these front-line providers a bonus at the end of the year for lowering the number of hospital admissions among their patients due to providing good, preventive health care? With such an incentive, they could spend more time with their patients and make better decisions on care that could translate into keeping their patients healthier and out of our very expensive hospital system. Less admissions, readmissions and fewer deaths equals savings in life and money. Even conservatives could get on board with such an idea, one would think.

For now, at least, our doctors have at least received a reprieve, and will have a much happier New Year, along with their patients.