AAFP, ACP, AOA Try to Stop Medicare Pay Cuts

Three groups, representing 250,000 physicians, took one message to key members of Congress Nov. 9 - 10: For patients' sake, fix the Medicare payment formula.

New doctors are not going to choose primary care if Medicare payment drops, and some primary care physicians will have to close their doors, AAFP President Larry Fields, M.D., of Ashland, Ky., told Rep. Joe Barton, R-Texas, chair of the Energy and Commerce Committee of the House of Representatives.

"We'd like to see a positive update" in Medicare payments, said Fields. He noted that unless Congress acts, the payment cut would be 4.4 percent in 2006 and 26 percent by 2010, compared with the 2005 payment level.

The Senate budget reconciliation bill, passed Nov. 4, called for a 1 percent increase in Medicare physician payments for 2006. But the House budget bill, not yet passed by the House at the time of the visits, did not request a change in the 4.4 percent pay cut slated to take effect Jan. 1.

"About 90 percent of my practice is Medicare," said American Osteopathic Association President Philip Shettle, D.O., of Clearwater, Fla. His statement underscored the impact the current Medicare fee structure could have on some primary care practices.

"I want doctors to be fairly compensated," said Barton. "I don't think it's fair to be cutting you when we'll give more money to hospitals and nurses and nursing homes, but I can't sit here and say we'll give you 2 percent more. There's not a pot of money lying around here that hasn't been used."

Barton asked the physicians, including leaders from the American College of Physicians, to "roll up your sleeves" and work with other health care professionals to figure out a fair system for Medicare reimbursement. "Then we ought to be able to help you," he said.

The exchange came during one of 13 visits AAFP, AOA and ACP leaders made to congressional offices Nov. 9 - 10. The Hill visits marked the first time leaders of the AAFP, ACP and AOA joined in contacting lawmakers face to face.

Each legislator received a packet of testimonials from physicians across the country about the impact of cuts in Medicare reimbursement.

"Some physicians will stop taking new Medicare patients" if the Medicare fee schedule is not changed, AAFP President Larry Fields, M.D., tells Madeleine Smith, a staff member for the House Ways and Means Committee's Subcommittee on Health.

The proposed drop in Medicare pay during the next few years "is an urgent situation," ACP President C. Anderson Hedberg, M.D., of Chicago told an aide to Rep. Roy Blunt, R-Mo., majority whip. "It's almost punishing. A few weeks ago, I visited about 90 medical students. Only five are going into primary care. You won't see it until somebody all of a sudden wakes up and says, 'Where's my doctor?'"

"Ninety percent of our internal medicine residents are going away from general internal medicine. They want to make ends meet. It's not that people are greedy. It's that the overhead is high," Lawrence Phillips, M.D., of Floral Park, N.Y., incoming chair of the ACP Council of Associates (residents and fellows), told an aide to Rep. Jim Nussle, R-Iowa, chair of the House Budget Committee. "Individual physicians in small practices can't make it work. Young people are choosing to avoid primary care."

Fields asked Madeleine Smith, a staff member who works with the House Ways and Means Committee's Subcommittee on Health, "Are there going to be doctors to take care of the one in five people who will be Medicare beneficiaries in a few years?"

Phillips advised Smith, "Our mentors can't make ends meet. We'll have an access problem for the general populace. People (older primary care physicians) will retire earlier. People currently in primary care will look for other avenues. People in the pipeline will say, 'No way.'"

In meeting after meeting, leaders of the three organizations also asked for a "fix" to the part of the Medicare fee formula that uses the sustainable growth rate, an expenditure target linked to the country's economic growth and the volume of physician services. The physicians suggested repealing the SGR and instead using a factor related to the cost of providing medical care.

At a press conference on Capitol Hill, Shettle said the proposed Medicare cuts would come at a time when "the number of Medicare beneficiaries is increasing, practice costs are rising and physicians are being asked to add new technologies to their practices. We are at a breaking point in our practices. Many of our members have told us that if the cuts are implemented, they will stop accepting new Medicare patients."

Hedberg agreed. "After adjusting for practice costs, the Medicare pay to primary care physicians is about half what it was in 1991," he said. "The (SGR) formula is a disaster for primary care practices. Doctors have said they're unable to keep up with the constantly rising cost of running their primary care offices."

"Congress should take action now to avert the looming crisis in access to primary care," said Hedberg.