Testimonials Regarding Medicare Cuts and Use of the SGR

(Please note that these submissions have been edited for length and, in some instances, clarity.)

I have a new start-up practice and am running my business with no staff. I am consistently surprised by how low Medicare reimbursement is compared with that of other payers. A significant portion of my practice is Medicare. I have previously been in practices that are closed to Medicare, and now I see why. Idealistically, I want to help and serve the Medicare population. However, as a businesswoman, I have to admit that I will not be able to afford to see the number of Medicare patients I currently see if the reimbursement drops lower.
Marian S. Bursten, M.D., Ph.D.
Practicing Family Physician
Fort Collins

I quit taking new Medicare patients in 2002 because of the poor reimbursement that did not meet my expenses for caring for these patients. With the new cuts due to take effect over the next five years, I will be forced to drop all Medicare patients from my practice. The worst part of the Medicare cuts is that the commercial insurance companies tie their reimbursement rates to the prevailing Medicare rate. Instead of taking a small hit, doctors take a large, across-the-board hit on all reimbursements, at the same time overhead is skyrocketing.

I work in a small, rural practice and stay out here because if I left, there would be no doctor to care for these elderly people. I can barely make payroll because of the large number of Medicare patients I see. If reimbursement cuts continue without some relief, I will be forced to leave so I can make a living. Eleven primary care doctors have left the nearby city of Pueblo, Colo., in the past two years because of declining reimbursements and increased unfunded governmental mandates. We need some help from Congress if primary care doctors are going to be able to continue coordinating the care of our nation's citizens. Otherwise, health care will become fragmented, with cardiologists treating urinary infections and gynecologists stabilizing heart attack victims.
Grady King Snyder Jr., M.D.
Practicing Family Physician
Colorado City

In my practice, we already limit Medicare to close family members of our other patients; we do not actively "participate." These patients are among our most time-consuming and complicated to treat, and yet our reimbursement is only about 70 percent to 80 percent of that for our non-Medicare patients. When one factors in our overhead of 50 percent to 60 percent, treating Medicare patients brings us about half the take-home pay of our other patients. If it weren't for the balance billing restrictions, we could require affluent patients to pay the full fee and open our practice to more Medicare patients in general, but this solution is illegal. Unless something is done, we will probably have to impose further restrictions on our acceptance of Medicare patients. I really don't have the time and energy to keep begging Congress for help each year, and the updates we begrudgingly receive have not kept up with inflation. It's simpler just to promote and design our practice around serving non-Medicare clients.
Thomas J. Allen, M.D., FAAFP
Practicing Family Physician
Fort Collins

I am one of the few physicians in my area still accepting new Medicare patients. If the sustainable growth rate formula is not repealed by Congress, I will be forced to close my doors to new Medicare patients.
Robert Bradley, M.D
Practicing Family Physician
Windsor

I am writing a quick note per this e-mail from our state academy. I am a 59-year-old family physician who has been in practice since 1975. There are four doctors in our rural Colorado group; the two oldest of our group currently take no new Medicare or Medicaid patients unless they are already in our practice. The two younger physicians take a limited number of new patients, but we have to limit our practice Medicare and Medicaid visits to less than 15 percent of total visits just to stay current financially. Our overhead is about 67 cents on the dollar. Medicare plus supplemental pays slightly more than 51 cents, and Medicaid pays 40 cents. It is obvious we lose 16 cents to 27 cents per dollar for patients in these categories. If we take more Medicare patients, we will go out of business. We try to listen, be thorough with our patients and limit ourselves to 25 visits per day. Therefore, we cannot increase volume to make up for below-cost reimbursement. Members of Congress need to reprioritize their priorities. We spend way more on the war and taking lives abroad than saving lives and improving quality of care here at home.
Richard A. Herrington, M.D.
Practicing Family Physician
Carbondale

I am the executive director of Primary Care Partners in Grand Junction, Colo. We are a group of 19 family physicians and 15 pediatricians. Each year, we struggle with the decision of whether to stop providing care for Medicare patients. Financially, it makes no business sense. We make just a bit more than we do with Medicaid, and our other lines of businesses have to subsidize our Medicare patients. This is not sustainable. If Medicare reimbursement does not rise at least as fast as our expenses in our practice, we will take every possible opportunity to reduce the number of Medicare patients that we care for. I cannot believe that federal fiscal policy has forced me to say this.
Roger Shenkel, M.D.
Practicing Family Physician
Grand Junction

I have a solo practice in Cortez, Colo., and see approximately 65 percent Medicaid and 10 percent Medicare patients. In anticipation of the upcoming cuts, no family medicine docs here in town are accepting new Medicare patients, and few are seeing new Medicaid patients. If a change in the formula is not made, no new Medicare patients will find physicians willing to take them. I cannot afford the shortfall and pay wages, malpractice, rent, etc., and still see patients. My hope for all these elderly is that the government will improve the reimbursements so that we can at least break even.
Hope K. Barkhurst, M.D.
Practicing Family Physician
Cortez

If the proposed Medicare fee schedule is cut as currently scheduled, it will force many of us to close our doors to Medicare patients. In Florida, where I practice, the cost of doing business continues to escalate while our reimbursement from managed care has remained flat. A further reduction in the Medicare fee schedule will at best force a restriction on Medicare patients seen by the practice and at worse continue to force many physicians in our specialty into other work or early retirement.
James Clower, M.D.
Practicing Family Physician
Jacksonville

If the sustainable growth rate formula is not repealed, the physician' take home pay in a solo practice will be lowered because he/she is already working with a bare-bones staff.
Russ Hostetler, M.D.
Family Physician
Plant City

The sustainable growth rate formula is obviously flawed and appears to be an attempt to help Medicare providers feel relieved to receive a nominal payment hike each year. Our practice expenses certainly increase at a percentage rate well above what a typical employee might receive as a cost of living increase each year, yet we feel we’ve accomplished a major victory when we avoid a Medicare reimbursement cut each year. Providers can't levy taxes or demand higher reimbursement for services from Medicare each year to cover our escalating practice costs, as most governmental or private industries are able to do. We are not even able to trim expenses imposed by well-intended state and federal governments. I feel we have reached a critical point where we are no longer able to work harder, smarter or longer hours just to maintain a fair and reasonable income as family physicians. We need a remedy for this reimbursement woe, and this poorly devised payment formula needs to be laid to rest. Enough is enough.
Greg K. Sloan, M.D.
Practicing Family Physician
Chipley

Physicians in our area are already beginning to limit new Medicare patients because of these cuts. The payment for services, office visits especially, does not pay for overhead. These cuts will really limit access for patients, especially for those who cannot afford Medicare supplemental insurance.
Roslyn D. Taylor, M.D.
Practicing Family Physician
Savannah

I can barely make enough profit to pay overhead on Medicare as it is. If there are any more cuts, I will be forced to quit. I cannot afford to see anymore Medicare patients if I receive any less.

For example, I did multiple cancer lesions on a patient with documented squamous cell carcinoma. By the low end of the “book,” the charges would be $1,250. I got paid $150. The greatest insult is that after getting essentially nothing for my services, there is the risk of an audit to try to get back some of the sum they paid originally. I did not sacrifice my life in medical school for this.
Wayne Hodges, M.D., Psy.D., M.A.
Practicing Family Physician
Savannah

If the Medicare cuts go into effect, I will be forced to find a position to supplant or to supplement the income from my nursing home practice, where most of my patients have Medicare as their payment source. Although I love taking care of seniors in the long-term care setting, it will no longer be feasible for me to do so.
D. Ann Travis, M.D.
Practicing Family Physician
Fayetteville

I live in a rural area in the northeast Georgia mountains. Approximately 25 percent of my practice consists of Medicare patients. If Medicare payments are cut any further, I will be forced to stop taking Medicare assignments. It is unreasonable for physicians to accept payment for their services in an amount that is less than the cost of caring for a patient. I've never known an attorney who didn't get their money up front. Why is it the physicians' responsibility to cut our fees when no other profession is required to do so?
Karen Austin, M.D.
Practicing Family Physician
Dillard

If the Medicare cuts continue, we will be forced to not accept Medicare patients in our practice. We are faced with rising costs of malpractice insurance premiums and escalating business expenses. We cannot get fair reimbursement for our care to the most needy and complex patients. All insurance payments are based on a percentage of Medicare rates, which means we are taking an across-the-board cut in our payments from all insurers.

With the rising costs of providing medical care, a cut in Medicare payments would affect both primary care physicians and specialists. As a family physician, I may have a more difficult time finding a specialist to do surgery on my Medicare patients or accept them for referrals. I may have to look into other options for Medicare participation such as becoming a nonparticipating provider and not being able to accept assignment. This would at least raise my reimbursement by 15 percent and allow me to collect at the time of service. I would end up losing some of my patients as a result. Also, if the payment cuts go into effect, then patients who are eligible for both Medicare and Medicaid, who already provide 20 percent less payment, would have the most difficult time finding a doctor who will accept them. These patients are the most vulnerable population, and it would leave them with the most limited access. If a payment cut goes into effect, I will let all of my patients know that Congress is responsible for a terrible mistake in calculation that directly impacts their access to medical care. I appreciate the advocacy of AAFP on this issue.
Ashwani Garg, M.D.
Practicing Family Physician
Lombard

I am a doctor in my mid 50s. Unless something changes, I anticipate that, when I go on Medicare, I will have the same problems with access to health care that patients on Medicaid now experience. The core issue is that Medicare reimbursement for common evaluation and management codes is already at or approaching Medicaid levels. Those levels do not allow a practice to sustain itself.
John G. Bradley, M.D.
Program Director
Southern Illinois University Family Medicine Residency
Decatur

Since we currently lose money providing care to Medicare patients, we would have to seriously consider limiting the number of Medicare patients we see if the current Medicare reimbursement formula is not corrected.
Rick Hampton
Associate Dean for Administration
University of Illinois College of Medicine
Rockford

Potential cuts in Medicare are extremely detrimental to rural areas of Iowa where family physicians care for a large percentage of Medicare recipients. Cuts in Medicare will jeopardize patient access to physicians. Where I practice, we are already experiencing difficulties recruiting primary care physicians and internists. A decrease in Medicare will only make recruiting and retaining physicians more difficult.
James Young, M.D.
Practicing Family Physician
Cedar Falls

If Medicare continues to cut reimbursement despite increasing costs in providing care to seniors, I will be forced to set significant, rigid limits on the number of Medicare patients I can see. This limit would be imposed at one time, not phased in: One month I would have my current 800 Medicare patients, the next month I would have 200. If I can't keep the doors open and the lights on, I'm unable to serve anyone.
Terry L. Mills, M.D.
Practicing Family Physician
Newton

Many primary care doctors are operating as small businesses with narrow profit margins; we do not have large reserves to fall back on. If our expenses are greater than our payments (operating at 1991 rates), we will be forced to close our doors to all patients, and the nation will face a health care accessibility crisis. Already many specialists are refusing to see Medicare or Medicaid patients, forcing more work on the family doctors. We need our legislators to realize the formula is broken. Every year we are faced with cuts to Medicare, and every year we need to lobby for restoration of funding. If we do not fix the formula once and for all, we will be forced to deny our seniors access to much-needed medical care.
Susan Rife, M.D.
Practicing Family Physician
Overland Park

Our practice is currently limited on how many new Medicare patients we accept because 20 percent of our patients are already on Medicare. We had to limit the number because of low reimbursement. If Medicare cuts the already poor reimbursement, then we will likely be forced to dismiss these patients. We cannot afford to stay open with reimbursements that won't even cover the cost of the overhead, let alone pay staff and the physicians for our time. It is imperative that Congress fix the problem, and not just by putting a Band-Aid on it. Our seniors deserve excellent health care, and the people providing it deserve to be paid appropriately for that care.
Marty W. Turner, M.D. FAAFP
Practicing Family Physician
Derby

Medicare patients represent about 38 percent of our patient encounters, which causes our write-off percentage to be above industry standards. While we would still try to continue to care for the people in our community, further cuts in these payments would cause a major health care hardship in our area.
Sara Ragsdale, D.O.
Practicing Family Physician
Fort Scott

If the Medicare formula is not fixed and we continue to see decreases in reimbursement, we will eventually be forced out of business. This would substantially impact our town and hospital and have a ripple effect throughout our community. Please fix the formula.
Brian L. Holmes, M.D.
Practicing Family Physician
Abilene

I am the only physician in a rural county in western Kansas. My clientele is almost completely Medicare. I am happy to serve this very special population of patients, and I feel that is a sacrifice I can make. However, if the sustainable growth formula is not repealed by Congress, I will not be able to continue to provide the care that these American citizens deserve and that I am happy to provide.
Mary Beth Miller, M.D.
Practicing Family Physician
St. Francis

Medicare cuts would create more financial problems for my practice, resulting in cutting office staff or reducing the number of Medicare patients I treat. Medicare patients are the sickest and require more nonreimbursable time from me and my office staff. We help Medicare patients with Indigent Pharmaceutical Program paperwork. In addition, home health and nursing home visits are not reimbursed what it costs to provide those services. I could no longer go to the nursing homes if Medicare is cut.
Gay Fulkerson, M.D.
Practicing Family Physician
Leitchfield

I’m very concerned about the proposed cuts in Medicare reimbursement. Not only will it make it harder for seniors to get the care they need, but it may also force us to consider becoming nonparticipating providers at some point, which would force additional cost and paperwork onto seniors. Another issue that may not have been considered is that many insurance companies reimburse us based on a percentage of Medicare-allowable costs. Cuts in Medicare may have a broad impact on our reimbursements across the board. Family physicians are already among the lowest-paid and most hard-working physicians. We simply cannot afford the proposed cut for next year and the more than 20 percent additional cuts proposed for upcoming years.
Jacob Vincent, M.D.
Practicing Family Physician
Bardstown

The proposed 4.4 percent cut in reimbursement would have a marked negative impact on my practice. As a solo family physician, my costs seem to spiral upward, and I have no way to recover these increases by increasing my charges; in fact my reimbursement continues to decline. I am struggling to provide health insurance for my employees (which increased 30 percent from last year). Please help, and don't increase my financial struggles further. I'm not sure a solo family medicine practice is viable in spite of my full patient load and attempts to charge appropriately and fairly. Decreasing reimbursement may drive me out of practice.
Richard J. Hempel, M.D.
Practicing Family Physician
Danville

I plan to close my practice to new Medicare patients.
Jacob Blum, M.D.
Practicing Family Physician
Louisville

The cuts would make it difficult to accept new Medicare patients into my practice.
John A. Lach Jr., M.D.
Practicing Family Physician
Louisville

I am a family doctor in rural western Kentucky. I work primarily as an occupational doctor for local industry; however, I also support our local county hospital as an active medical staff member, regularly caring for patients in the inpatient setting. My Medicare patient load is about 80 percent. While my time spent on inpatient care is only about 10 percent of my workload, a reduction in reimbursement from Medicare would make the benefit too far out of line to justify the effort. I would likely choose to no longer see inpatients, or to opt out of Medicare, which would make hospital work ineffective for our area. My scenario is not unique in rural areas. I am somewhat insulated because the bulk of my income is unaffected by government program reimbursement. Others are less fortunate.
Michael A. Chunn, M.D.
Practicing Family Physician
Calvert City

I have been in private practice for almost 27 years now, and by most standards my practice is very busy and successful. Nevertheless, my net practice income is one-third what it was in 1996. Reimbursements have plummeted, and overhead has skyrocketed. Any further reduction in reimbursements will probably force me to close my practice down and do something else.
Ronald J Hamm, M.D.
Practicing Family Physician
Middletown

It is an unfortunate reality, but I feel that when reimbursement suffers, patient care also suffers. And suffering is what we in primary care are working so hard to remedy. With the increased cost of running a business in conjunction with the decreased reimbursements we have already seen, particularly if the proposed cuts go through, then offices such as ours are going to be forced to cut services and/or attempt to see more patients in the limited time we already have. I feel this would be a detriment to our patients. My patients and I would be most grateful if these cuts were not passed.
David A. Jones, M.D.
Practicing Family Physician
Eminence

If Medicare reimbursement is cut, I will discontinue Medicare within one year. It is already my intention to discontinue Medicare because of low reimbursement -- this would substantially speed up that process.
Jim Roach, M.D.
Practicing Family/Integrative Medicine Physician
Midway

The projected cut in Medicare reimbursement would severely affect my practice. As a solo practitioner, my overhead has increased year by year. This year alone, the rent has increased 3.5 percent, and health insurance premiums for me and one employee increased 40 percent. The elimination of Medicaid secondary insurance payments for the differential not paid by Medicare more than a year ago by the state of Kentucky forced me to stop accepting new Medicare and Medicaid patients. If Medicare reimbursement falls as projected, I shall be forced to close my practice to new Medicare patients. This also tells me that I had better find another practice opportunity or livelihood in the near future. This is not something I relish at age 42.
D.G. Dillman II, M.D.
Practicing Family Physician
Lexington

I quit taking new Medicare patients more than a year ago.
Kenneth L. Oder, M.D.
Practicing Family Physician
Taylorsville

The proposed cuts will lead me to close my practice to any further Medicare patients.
Buddy Hurt, D.O.
Practicing Family Physician
Harrodsburg

Medicare reimbursement is already inadequate, and if it goes lower, I will be forced to stop caring for citizens whose primary payer is Medicare. To illustrate: A typical Medicare patient came to see me this week for ongoing care of multiple problems. By the end of the visit, I had provided a detailed, head-to-toe exam, with the exception of a pelvic or rectal exam. I addressed about a half-dozen diagnoses. I spent 38 minutes face-to-face with the patient and another 15 minutes to document the visit and schedule a colonoscopy. When each of her lab results come back to me, I will spend another five minutes on each report and will send the patient letters about her labs. All told, this patient’s care will take up about 67 minutes of my time, for which the gross Medicare payment is $76.91. Out of that amount, I have to pay overhead expenses, which I estimate to be about $43 per hour based on a five-day workweek.

So, Medicare thinks my work is worth less than $35 per hour. By comparison, I had an eye exam this week. I paid $99 to the optometrist for an exam of one organ system that took him 10 minutes face to face, plus some documentation time. I had to change the locks in the office a couple weeks ago. The locksmith charged $80 for a task that took him 20 minutes and an extra $40 after-hours surcharge because he arrived at 4:31 p.m. and after 4:30 is “after hours.”

This can’t go on! When all other businesses are raising their prices and adding surcharges, but my “prices” are forced down by Medicare, it becomes impossible to stay in business. If Medicare rates are not increased, I will have to stop letting new Medicare patients into my practice, and if rates decrease, I will have to opt out and stop caring for the patients I have now. And if Medicare rates drop, the impact on private insurance rates may force me out of business entirely, even if I don’t take Medicare.
Annie Skaggs, M.D.
Practicing Family Physician
Lexington

My practice is approximately one-third Medicare patients. The current low reimbursement rates have forced me to stop caring for nursing home patients. With these cuts, I will likely have to lay off staff and stop taking new Medicare patients. Ultimately, I may need to close my practice entirely.
Eugene Newmier, D.O.
Practicing Family Physician
Cambridge

Physicians should exercise all precautions before considering withholding services to seniors, whether by withdrawing from Medicare or closing the office. Physicians take advantage of measures to assist seniors in retirement planning, so there is some give-and-take. Maybe some tax breaks could be given as incentive to doctors taking care of seniors at reduced rates. The bigger problem is that other carriers follow Medicare’s rates, so any cuts to Medicare create a domino effect.
Ben Oteyza, M.D.
Family Physician
Bel Air

The Medicare cuts and the flawed formula will have devastating effects on my practice and those of my colleagues here in southeastern Michigan. This region has yet to show any recovery from the recession. If the Medicare cuts go through and the other payers also reduce their fees, many practices will close. At the very least, I will be forced to close to new Medicare patients.
Chris Bush, M.D.
Practicing Family Physician
Riverview

Two things will happen if Congress does not correct the sustainable growth rate. For the first year, I will not accept any new Medicare patients. Beyond that, I will quit my practice and run for Congress.
Rob Reneker Jr., M.D.
Practicing Family Physician
Byron Center

In a rural practice that is 30 percent Medicare and 25 percent Medicaid, it is very difficult to recover our losses with a Medicare fee rollback. Most patients are under contracted fees or cash-paying fee-for-service and cannot absorb a cost-shift. We won't stop seeing Medicare patients, but lower reimbursement further hampers an already difficult recruitment process, ultimately reducing access for all rural patients.
Richard Horecka, M.D.
Rural Practicing Family Physician
Benson

At the present time, I am not willing to take the gamble of accepting new Medicare patients until the issue of further degradation in the fee schedule is rectified.
Keith Ratcliff, M.D.
Practicing Family Physician
Washington

Despite all of the highly reimbursed interventions available from our subspecialty colleagues, our Medicare patients are more complicated, sicker and take more time. To pay less for increasingly complex care will inevitably result in less care at lower quality from fewer primary care physicians.
Steve Zweig, M.D.
Family Physician
Columbia

My practice wants to expand and add staff and services to better accommodate our patients, of which a large proportion are Medicare, but that will be directly affected by Medicare rate changes.
Thomas Kelley III, M.D.
President, Missouri AFP
Practicing Family Physician
Liberty

Medicare patients are the most complex and time-consuming patients in my practice. Not only are many of them sick with multiple problems, every time the program is "simplified," there is more paperwork for me. I currently see Medicare insureds at a significant discount compared to every program but Missouri Medicaid. Eight months ago, I ceased taking new Medicare patients and plan only to continue to see current patients who "age up."
Arthur Freeland, M.D.
Practicing Family Physician
Crown Family Medicine
Kirksville

At the present time, I am not willing to take the gamble of accepting new Medicare patients until the issue of further degradation in the fee schedule is rectified.
Keith Ratcliff, M.D.
Practicing Family Physician
Washington

Despite all of the highly reimbursed interventions available from our subspecialty colleagues, our Medicare patients are more complicated, sicker and take more time. To pay less for increasingly complex care will inevitably result in less care at lower quality from fewer primary care physicians.
Steve Zweig, M.D.
Family Physician
Columbia

My practice wants to expand and add staff and services to better accommodate our patients, of which a large proportion are Medicare, but that will be directly affected by Medicare rate changes.
Thomas Kelley III, M.D.
President, Missouri AFP
Practicing Family Physician
Liberty

Medicare patients are the most complex and time-consuming patients in my practice. Not only are many of them sick with multiple problems, every time the program is "simplified," there is more paperwork for me. I currently see Medicare insureds at a significant discount compared to every program but Missouri Medicaid. Eight months ago, I ceased taking new Medicare patients and plan only to continue to see current patients who "age up."
Arthur Freeland, M.D.
Practicing Family Physician
Crown Family Medicine
Kirksville

Our rural family office is a busy medical practice serving 30 percent Medicare patients. Our operating costs have increased by more than 18 percent over the past four years. Medicare payment increases have fallen so far short of meeting that increase that we are, in effect, cost shifting from other patients to cover care of our elderly.

This cost shifting cannot continue indefinitely. If reasonable increases in the Medicare fee schedule cannot be enacted, we will have to face a tough decision about opting out of Medicare and ceasing to care for the elderly patients who need us most.
Kathleen J. Smith, M.D.
Rural Practicing Family Physician
Littleton

Almost all family physicians will not accept new Medicare patients anymore. Who will take care of our seniors? More cuts in Medicare only light the flames even more, causing more family physicians to turn away senior patients.
Mark Krotowski, M.D.
Chair, Department of Family Medicine, Brookdale University Hospital
Clinical Associate Professor, Downstate SUNY Health Sciences Center at Brooklyn Medical School
Brooklyn

Family health practices operate on a narrow profit margin. I am competing for staff members with more highly reimbursed specialties, and I am having great difficulty affording staff. One of my partners left for a better-paying government job. If I cannot pay staff better than minimum wage and still offer a living wage to my partners (while accepting less than one-third of the net myself), I will soon be a solo practitioner. A cut in Medicare reimbursement will be the final straw. We will be closed in less than one year and leave about 7,000 folks in our suburb without care, because there are no nearby family medicine practices taking new patients.
Philip Kaplan, M.D.
Practicing Family Physician
Manlius

I am opposed to the proposed Medicare reimbursement rate cuts. If these cuts are passed, our office would be forced to stop seeing new Medicare patients. We would also be forced to limit the current number of Medicare patients. Because private insurance company reimbursement rates are closely tied to Medicare rates, the proposed cuts will have a negative impact across all our patients. We would be forced to reevaluate the services we provide to patients covered by all insurance and perhaps reduce the services that we can offer.
Andrew J. Merritt, M.D.
Practicing Family Physician
Marcellus

Our mid-sized multispecialty group (approximately 50 attendings as well as a family medicine training program with 18 residents) is facing ongoing deficits that will be further aggravated by these proposed cuts. We are currently struggling to pay and maintain our employees at a competitive wage and may be forced to consider changes in our current mission: "guaranteed access to excellent health care for all, regardless of their ability to pay." We feel unappreciated; the need will become apparent when these patients no longer have primary care physicians. The consequences will be unhealthy and very costly in the long run.
Mark Josefski, M.D.
Practicing Family Physician
Kingston

I stopped accepting new Medicare patients because the decreasing reimbursements do not cover my expenses (rent, utilities, salaries, malpractice insurance), which continue to increase yearly. More and more physicians are going to give up Medicare because the poor reimbursements render them not able to keep up with their expenses.
Bruce L. Mertz, M.D.
Practicing Family Physician
Cleburne

The proposed payment cuts to physicians will result in more and more primary care physicians opting out of Medicare and refusing to see Medicare patients. The time required to see a Medicare patient is already disproportionate to the reimbursement received because these patients have more chronic diseases and thus require more medications, tests, counseling and education. Last week, I saw a Medicare patient with multiple chronic diseases, including dementia and impaired hearing and vision. My office staff spent more than two hours helping the patient fill out the paperwork, registering the patient and assisting her in moving from the waiting room to the back office. That was in addition to my interview and examination. For this we will receive about $52. This does not cover my overhead. By cutting payments to physicians even further, CMS will force us to stop seeing Medicare patients and see only younger, healthier patients or give up traditional medicine and let people pay us cash for Botox, cosmetic procedures and "anti-aging medicine."
Mary Angela Knauss, M.D.
Practicing Family Physician
Pearland

Currently, I accept only existing patients transitioning to Medicare, a relatively small number. However, if cuts occur, I will likely avoid this group altogether and agree to see them only as fee-for-service patients. The reimbursement for E and M codes is already too low.
David Gabriel, M.D.
Practicing Family Physician
Austin

Irrespective of our ethical thoughts on what medicine should be, in the end, it remains a business. And as with any business, tough decisions sometimes have to be made in order to keep the company solvent. Lawmakers who have built-in retirement plans and health care paid for by the taxpayers of this country have the luxury of not having to use the very system they demand we use. I work in a climate where my reimbursements go down each year, insurance companies increase their premiums, and lawmakers vote themselves raises. If I am forced to stop taking new Medicare patients because of a tough financial decision, and enough people like me do the same, and we educate our Medicare patients on this issue (like I already do), then these older voters can maybe make a difference over time. Reducing reimbursement to health care providers while acknowledging the fact that the cost of delivering that care goes up every year is wrong. Expecting health care providers to continue subsidizing the government-dictated system at the expense of their own retirement and their children’s futures is unfair. Forcing health care providers into a position where they are no longer willing to, or are not fiscally able to, care for the elderly is unfair.
Robert Lee, M.D.
Practicing Family Physician
Granbury

I stopped taking Medicaid patients five years ago because the rules became so onerous that I simply gave up on the system. If Medicare is going to be worse, I may take a cue from my fellow family physicians here in El Paso and stop taking Medicare patients.
Perry T. Wolfe, M. D.
Practicing Family Physician
El Paso

I work in a large multispecialty clinic that is part of a 13-clinic network in central Texas. We see a large number of Medicare patients. Medicare reimbursement does not come close to covering the cost of treating these patients, who often have multiple medical problems, such as diabetes, hypertension, chronic obstructive pulmonary disease and coronary artery disease. Our clinics have already decided to not accept any Medicare patients who do not have supplemental insurance to help offset the cost of their care. Most of the doctors in this city of 130,000 do not take new Medicare patients either. Reimbursement levels that are declining below the cost of caring for these patients is the fundamental problem. Health care costs are rising annually, but Medicare reimbursement has not kept pace.

We are willing to accept pay-for-performance if we can expect increased reimbursement when we meet quality standards. The current proposal from the Medicare Payment Advisory Commission to take 1 percent of Medicare reimbursement away from everyone and redistribute it to the best performers penalizes too many doctors. CMS should increase reimbursement rates for all doctors and then reward the best performers with a bonus for higher-quality care.
Troy Fiesinger, M.D.
Practicing Family Physician
Waco

Physicians who participate in Medicare do it in order to provide high-quality and needed care to our senior citizens and patients with disabilities. We want to ensure that they have access to care for their medical needs. It is getting more difficult every day for physicians to afford to stay in the program, as the federal budget for Medicare continues to be reduced.

Congress is now actively considering a 15 percent cut across the board to all federal programs. This cut would be on top of the 4.4 percent cut already proposed for physicians who care for Medicare patients. We need to be free to focus on caring for our patients instead of fighting for fair Medicare reimbursement.

For the past decade, Medicare reimbursement rates have dropped below the operational cost of a practice. The cuts being considered, combined with increasing practice costs, will force many physicians to stop taking Medicare patients.

I strongly urge support of The Preserving Patient Access to Physicians Act of 2005 (S. 1081), which calls for Medicare to increase physician payments by at least 2.7 percent in 2006 and by 2.6 percent in 2007. Please also support H.R. 2356, which fixes the physician payment formula, and support efforts to head off cuts to the physician payments under the Medicare program.
Armando Jarquin, M.D.
Family Physician
Houston

The SGR (sustainable growth rate) should be an SAR -- sustainable access rate. The calculation for primary care should be the rate that maintains better yet improves access to care for the Medicare population.
Robert Allen Youens, M.D., FAAFP
Family Physician
Weimar

We live in a small retirement community where the majority of our patients are on Medicare. We have no choice but to see Medicare patients. Other insurance companies usually align with Medicare reimbursement, and they will pay less according to what Medicare pays. If the cut occurs, my husband and I will be forced to leave private practice, thereby leaving patients without a doctor. With the pay cut, it will be very difficult to give our staff raises. This affects their lives. The costs of rent and utilities and supplies continue to rise dramatically. I don't know how we will make it. I don't know who would even want to go into medicine anymore. I am office manager, I do all the billing for my husband and I fill in as receptionist and nurse if someone is out. We both work extremely hard.
Kay G. Llanos, R.N.
Arturo R. Llanos, M.D.
Family Medicine Practice
Kerrville

I dare Congress to cut Medicare by the proposed 15 percent. Family physicians would all close to new Medicare patients, and there would be a major access crisis. The AARP and other organizations would have to work with the AMA, AAFP and others to revamp the system. If doctors continue to support Band-Aid attempts to fix things, then we will continue to pay for it out of our own wallets. Mine is already empty from still paying on my $180,000 medical school debt, and I won't make my family sacrifice any more in the name of service. Let the crisis begin so that doctors, especially primary care doctors, can be paid fairly.
Beverly Zavaleta, M.D.
Practicing Family Physician
San Antonio

I can barely afford to run my practice at current (payment) rates. Doctors haven't had a raise in years. It is particularly difficult for young physicians, like myself, to get established in practice when costs are at an all-time high and reimbursements for services are at a pitifully low rate. I have huge medical school loans, huge overhead expenses and huge business start-up expenses. If there are any further cuts in the Medicare reimbursement, I will have to start operating more of a concierge-type practice and accept cash only. How many seniors do you know who can afford that?
Carl A. Davis, M.D.
Practicing Family Physician
Nacogdoches

I am a solo family physician in private practice treating a large number of patients and families. Approximately 47 percent of my patients are Medicare, and most, if not all, of my commercial insurance contracts and the state of West Virginia's Medicaid program are tied to a percentage of the Medicare fee schedule. A 4.4 percent reduction in that fee schedule will result in approximately the same percentage reduction in my operational budget and even our retirement program.

In some sense, you could say we're really government employees because the source of our income is either direct from state or federal government payers or tied to the system of how government pays. Federal employees get a cost of living raise -- what about those who provide health care?
David Avery, M. D.
Practicing Family Physician
Parkersburg