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Medicare cut may deny health care, critics say
© St. Petersburg Times, WASHINGTON -- The nation's physicians warned Tuesday that many Medicare patients could be deprived of care if the government proceeds with an announced 5.4 percent cut in their reimbursement fees, beginning Jan. 1. It is the fourth cut in inflation-adjusted Medicare payments to physicians over the last decade, and it comes at a time when government officials are concerned that earlier cutbacks in health care have weakened the system's ability to respond to bioterrorism. Richard F. Corlin, president of the American Medical Association, said that unless Congress acts to restore the cut, Medicare patients will be "suffering from the same access problems that challenge Medicaid beneficiaries." Members of Congress sympathetic to the physicians have drafted legislation that would reduce the 5.4 percent cut to a reduction of only 0.9 percent, but there is no guarantee that such legislation can be enacted before the end-of-the-year adjournment. These lawmakers predicted a 5.4 percent cut in physician fees would force some doctors to leave the profession, stop taking new Medicare patients or abandon communities where reimbursements are the lowest. Rep. John Dingell, D-Mich., called it a "national calamity." Unless Congress acts, physicians in the Tampa-St. Petersburg area, who now receive $51.41 for a midlevel office visit with an established patient, would get $48.65 for the same visit after Jan. 1. Likewise, a $1,508.77 reimbursement for a hip replacement would be cut to $1,427.57. In St. Petersburg, Michael Reilly, a general practitioner and chief of staff at St. Anthony's Hospital, said the depth and breadth of the cut came as a surprise to many doctors. He added that the fee cut is unusual because it will affect virtually all physicians, not just the specialists who have been the target of past cuts. Likewise, Michael Wasylik, a Tampa orthopedic surgeon, said the Medicare fee cut will have an impact on all his reimbursements, since managed care contracts are often tied to Medicare rates. "I'm not just going to get a smaller check from the government," he said, "I'm going to get a smaller check from everybody." Reilly added that more doctors in the area are being paid directly by Medicare since many managed care companies have dropped Medicare patients. "The HMOs, even though they were controversial and bad for specialists, were probably good for primary care doctors," he said. "Now that they are going away, it makes it a little more difficult. Now we're getting squeezed a little more." The cut in physician fees was announced Oct. 31 by the agency that administers Medicare, but the announcement went virtually unnoticed in the crush of news surrounding the war on terrorism. Wasylik said he learned about it only Tuesday. The fee cut is based on a complex economic formula adopted by Congress in 1997 to help stem inflation in the health care industry. But in each of the past three years, Congress has passed a "giveback" bill to restore cuts that were deeper than expected. As a result of the givebacks, the cumulative increase in physician fees has been 15.9 percent since 1998, compared with medical inflation of about 9.3 percent in the same period. But the AMA notes the doctors' Medicare payments will have averaged an annual increase of only 1.1 percent over the past decade, if the announced cut for 2002 is not changed. Tom Scully, administrator of the Centers for Medicare & Medicaid Services, said the formula enacted by Congress gives his agency "no wiggle room" to adjust the cut. At the same time the fees are being cut, he noted, the government has added annual glaucoma screenings and medical nutrition therapy for those with diabetes or renal disease to the list of preventive services covered by Medicare. Under a bill sponsored by Rep. Michael Bilirakis, R-Palm Harbor, among others, the Medicare Payment Advisory Commission would be directed to conduct a study to be completed by March 1, recommending a new formula for figuring rate adjustments. Wasylik said the cuts come at a time when malpractice rates also are skyrocketing. "A lot of my colleagues are seeing their malpractice go up 100 percent, so it's a double whammy," he said. While doctors in other areas might just drop out of the Medicare program in response to these cuts, Wasylik said that is not possible in the Tampa Bay area, with its high concentration of retirees. Wasylik said he has called his representatives in Congress to complain about the cut. "Their aides listened, but they didn't respond," he said. "I doubt it's going to change." In addition to the AMA, the groups seeking legislation to trim the cut to 0.9 percent include the American Association of Orthopaedic Surgeons, the American Academy of Ophthalmology, the American College of Surgeons and the American Society of Internal Medicine. -- Times staff writers Kris Hundley and Wes Allison contributed to this report.
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