Americans are facing threats to their access to medical care. Their family physicians are struggling to remain open after years of instability in Medicare. These physician practices depend on decisions that will be made by Congress in upcoming months.
Whether a family physician can remain in practice depends to a large extent on Congress. Unless Congress acts to halt a mandated 29.5 percent Medicare payment cut before Jan. 1, 2012, more than one in 10 family physician practices could be driven out of business. Unless Congress and the President approve recommendations by the Joint Select Committee on Budget Reduction an automatic, across-the-board cut of 2 percent will be applied to Medicare provider payment.
We asked family physicians about the impact of drastic Medicare pay cuts. Here is what family physicians say….in their own words.
“In Massachusetts our Medicare reimbursement rates are already being subsidized by the commercial insurance rates, but the commercial rates are regularly dropping due to our Commonwealth's health care changes.
“If we are reduced by 30% more I will be unable to afford to provide care to Medicare beneficiaries. Period. There will be no other option.
“It is a clear abrogation of the government's promise to provide medical care to seniors. Moreover, I feel this puts a burdensome and unique tax on me who, as a family physician, finds myself already at the bottom of the reimbursement scale of physicians. Already it is nearly impossible to attract others to primary care. This would put the coffin nail in the hopes to increase primary care physician ranks.
“The solution is not to reduce the unit costs of care, but to put deterrents on the increasing demands of all beneficiaries for the latest and most expensive technologies, and to reduce the malpractice threat on us.
“Someone in decision-making roles has to understand the impossible pressures already on us in the current environment. Putting across-the-board decreases in reimbursement will simply shut off seniors’ access to care.
“I believe we can work together to reduce expenditures, but only when ALL who demand services have the same incentives to utilize resources at an appropriate level. I have already had to stop taking NEW Medicare patients due to the low levels of reimbursement. Please, do not cut the jugular with the foolish 30% reductions being discussed.”
Gregory A. Bazylewicz, MD
“I opted out of Medicare 2.5 years ago. Every time I see a Medicare patient in my office (with whom I have a private contract outside the Medicare system), who pays me cash out-of-pocket, I wish that I could at least go back to a "non-participating" agreement, because I know that seniors on a fixed income have budget troubles of their own. But I cannot enter into a business arrangement that puts one-third of my income at risk. I’ve been in practice 11 years, and for the first five was losing money to the insurance system. Now that I have a cash-based practice, I can make ends meet, and pay my staff, my rent, my malpractice, and even myself. So many of my colleagues cannot.
“A 30% cut from Medicare would ensure that I did not go back to a participating or even non-participating status. And I am sure that it would be the final nail in the business coffin for many of my family practice colleagues.
“I would be happy to discuss this with anyone who would listen. I've given up reaching out to the legislature, as I have been met with form letters if I get any response at all.
“We need more than just an SGR fix. We need real and true health care reform. Where doctors are paid fairly and patients can afford coverage.
“If the Medicare system were improved, payments were fair, and coverage remained thorough, and we gave all Americans the option to "buy in" to the Medicare system, it would create a robust insurance plan with plenty of cash flow and a balance of healthy young members to the older or disabled members. It would be, theoretically, free from the profit-driven goals that the current insurance based system thrives upon. And we would be a huge step closer to true "health care for all".
“In the meantime, I will continue at my cash practice 3 days a week, and the free community based clinic for the uninsured 2 days a week.”
Elizabeth Crowley, MD
Cape May Courthouse, NJ
“It's simple. A 30% cut in Medicare payments will mean I will have to close my solo rural practice. It would be the final blow as my overhead continues to increase while my reimbursements, at best, stay flat. This would also give my commercial payers a reason to decrease their payments as they tie their own payments to physicians as a percentage of the Medicare rate. This should be a huge concern to the general public as I am sure it will only add to the erosion of primary care which has proven over and over again as a cost saver to our health care system. In the long run, I would expect to see health care costs increase if payments to physicians decrease as more patients will have to seek care in the ER which may be the only place for them to go.”
Mike Gorman, MD
“A 30% cut in Medicare physician payments will severely cripple primary health care in Georgia. We already have a situation in the state where there has been no increase in Medicaid payments in 11 years, while expenses continue to go up and up. There are family physicians in the rural areas of the state who have to work two or three jobs to continue to survive because they lose money each time they see a Medicaid or Medicare patient, which the majority of their patients are.
“A 30% pay cut will drive some of these small business men and women out of business as they will no longer be able to cover overhead expenses. Is this what we really want? Decrease the access to health care in the most needy areas of our nation that need it the most? In the end these patients will seek care later in a disease course, and from providers that will end up costing everyone more (the ER). Not a good way to save money.”
Leonard D. Reeves MD FAAFP
Share this page
Alert: Message field is required.
You must sign in before you can share a page on AAFP connection.
Preserving Access to Care in Budget Reduction Debate
What FPs Say