Medicare payment issues worry doctors

Download PDF Copy

Oct 27 2009

The issue of Medicare payment cuts to doctors still looms, causing some physicians to shun Medicare patients and others to push for greater reform. Many worry that doctors may boycott the program if the planned 21 percent cut in payment rates goes through in 2010 while others complain about low Medicare reimbursement rates for certain procedures and geographic areas.

CNNMoney looks at the concerns of physicians at Kansas City Internal Medicine, the city's largest private group practice with about 65 percent of its nearly 70,000 active patients age 65 or older. Many physicians in the practice have "stopped accepting walk-in Medicare enrollees." Dr. David "Wilt and his colleagues say they are shunning the area's growing senior population because they believe Medicare doesn't reimburse physicians enough to cover the cost of care. ... Wilt -- and doctors with lots of senior patients -- are especially troubled by a 21% cut in Medicare payments to physicians scheduled to take place in 2010. Last week, the Senate voted against stopping that cut, and more annual cuts over the next decade, from taking place. ... Physicians say a boycott against Medicare has already begun because they are tired of dealing with the yearly threat of a payment cut."

"The federal government's Center for Medicare and Medicaid Services (CMS) said it is aware of anecdotal reports of doctors not taking Medicare beneficiaries. However, the agency maintains that its own data, and other industry reports, show only a small percentage of beneficiaries unable to get physician access. CMS said 96.5% of all practicing physicians, nearly 600,000 doctors, currently participate in Medicare. ... Federal law requires that Medicare physicians' payment rates be adjusted annually based on a sustainable-growth rate that's tied to the health of the economy. Physicians face a rate cut every year, although Congress has at the last minute blocked those cuts from happening in seven of the last 8 years." Both the AARP and the American Medical Association (AMA) want a long-term solution such as a permanent repeal of the reimbursement formula (Kavilanz, 10/27).

U.S. News & World Report also reports that Medicare costs are critical to healthcare reform and that many doctors say their support for reform is based on changes to Medicare payments (Garber, 10/26).

Radio Iowa reports that the Iowa Medical Society is pushing for Medicare payment reform and that the state's hospitals and doctors have consistently been paid less than their urban counterparts. That is because of the "Medicare payment formula that discriminates against sparsely populated states like Iowa" (Henderson, 10/26).

Meanwhile, The Wall Street Journal reports on a Medicare official who is key to controlling spending: "Barry Straube's office decides what drugs and devices Medicare covers. Dr. Straube, a kidney specialist and a former insurance executive, is Medicare's point man on which drugs, devices and medical procedures the $400 billion-plus program will cover. He might not have the president's ear like [White House budget chief Peter] Orszag, but as Medicare's top medical official, he has a big influence over health-care spending -- and the fortunes of health-care companies."

"Under health-care legislation taking final shape in Congress, many lawmakers and the Obama administration want Medicare -- the nation's biggest purchaser of health care -- to more closely tie payments to the quality of care. That is likely to mean more work for Dr. Straube and his staff within the Centers for Medicare and Medicaid Services, the Department of Health and Human Services agency that oversees Medicare and Medicaid. ... In deciding what treatments Medicare will cover, Dr. Straube's office looks at what is considered 'reasonable and necessary' for beneficiaries" (Zhang, 10/27).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.