BY J. MICHAEL BRODIE
Bush administration officials have proposed cutting Medicare payments to doctors by 4.2 percent at the beginning of 2004 unless Congress passes legislation to reduce or eliminate the cut.
The proposal, published in the Federal Register Aug. 15, is open for public comment until Oct. 7.
The U.S. Senate and House of Representatives have passed different Medicare reform and prescription drug benefit bills. A conference committee is attempting to work out the differences between the bills and reach a compromise that can pass both houses and be sent to President Bush.
In 2002, Medicare reimbursement was reduced by 5.4 percent. In February of 2003, Congress prevented another cut and allowed a modest 1.6 percent increase.
The AAFP encourages you to contact your lawmakers and explain the impact Medicare cuts have had or may have on your patients. To send your lawmakers an e-mail, go to http://capitol.aafp.org/, click on "Tell Congress to Fix the Flawed Formula," and follow the prompts.
On Aug. 11, administration officials said the Medicare rule would give doctors a "slightly higher" allowance for malpractice insurance costs in 2004 because of "sharp increases" in providers' medical malpractice premiums. But this slight rise would be offset by decreases in the work and practice expense components of the fee schedule. The looming 4.2 percent cut is related to "slow growth in the economy and to a significant growth in physician outlays," said officials.
"This proposed cut demonstrates some of the current flaws in the system," said AAFP President James Martin, M.D., of San Antonio. "Health care costs and practice overhead are not tied to the economy, liability premiums are rising far out of proportion to the current 'adjustments,' and the productivity adjustments are inappropriate for primary care. Patients' medical needs are also not tied to the economy. A number of studies suggest that patients' medical needs increase during economic downturns."
The administration said that the 2004 payment reduction would not adversely affect Medicare beneficiaries or their access to care and that Congress could prevent the payment reduction. However, AAFP data showed a 28 percent increase in members not accepting new Medicare patients after the 5.4 percent cut in 2002.
Under the House bill, Medicare payments to doctors would increase at least 1.5 percent per year in 2004 and 2005. The Senate bill says the Medicare payment formula is "fundamentally flawed" and beneficiaries' access to care "may be compromised" if Congress does nothing.
"The administration may not be in touch with reality," Martin said. "The Academy's own surveys show that more than one in five of our doctors are not even taking new Medicare patients now. Lower reimbursement rates will only add to that problem. There will be an access problem."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
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