Congress delays cut in Medicare payments

Congress put off a big decision last week.

When lawmakers voted to extend unemployment benefits, they also postponed until April 1 the workings of a law that would cut up to $285 billion from Medicare payments to doctors over the next 10 years.

With physician groups warning the cut would force doctors to reduce the number of Medicare patients they treat, Congress left current rates in place. The action spared doctors a 21.2 percent reduction in payments but did not alter the formula that requires the cut.

Dr. Thomas Sparkman of Cape Girardeau, president of the Missouri State Medical Association, joined the lobbying rush in Washington. At 78, Sparkman sees patients at almost a dozen nursing homes in the area.

"There are already in St. Louis currently physicians who will no longer accept new Medicare patients," Sparkman said last week. "The reason for this is all the extra paperwork and hassle we have to go through for our money. Many other physicians already limit the number of Medicare and Medicaid patients they get."

The debate over doctor payments involves spending goals set in 1997 known as the Sustainable Growth Rate formula.

Enacted as part of a balanced-budget plan, the law has called for cuts in doctor payments almost every year since it was passed. Congress generally blocked those cuts, opting to increase payments to doctors instead.

"While recent Medicare legislation has provided temporary relief from SGR cuts, the budgetary situation has been made worse in the long run by simply moving the cuts to the next year," warned a fact sheet issued in October by the American Medical Association. "This increased the severity of the cuts and raised the cost of enacting a permanent solution."

Medicare covers every American over 65 and people receiving Social Security payments for a long-term disability. It is supported by a payroll tax shared by workers and their employers. The payments included in the Sustainable Growth Rate formula cover only physician charges, not those for hospital treatments or prescription drugs dispensed at pharmacies.

Physician groups want to scrap the formula, setting current rates as the basis for future spending. That will provide accurate forecasts for future costs and sustain jobs in physician's offices, the AMA said in the October fact sheet.

Many Missourians already have difficulty finding a doctor or affording a visit, Sparkman said. Of the state's nearly 6 million people, 18.6 percent live in a designated primary care shortage area and 15 percent reported in a survey that they were unable to see a doctor in the past 12 months due to high costs, according to AMA data supplied by Sparkman.

Doctors can require patients covered by Medicare to pay office visit charges out of their own pocket, as five physicians at one Mayo Clinic family practice clinic in Arizona did last year.

"We really are in an insane picture of doctors required to keep practices open with costs increasing and to have payments reduced by 20 percent per year," Sparkman said.

One roadblock to altering the formula is recently enacted budget rules requiring that every increase in spending be offset by a corresponding cut in another program or a new source of revenue. Intended to help bring the annual federal deficit -- $1.4 trillion in fiscal year 2009 -- under control, it will prevent a permanent change in the formula without an exemption.

U.S. Rep. Jo Ann Emerson, R-Cape Girardeau, said fixing the Sustainable Growth Rate formula is "many, many, many billions of dollars. Because it is such a lot of money, including it in health care reform is at best a 50-50 chance."

The 8th Congressional District has the highest concentration of Medicare recipients of all Missouri districts, Emerson said.

The Sustainable Growth Rate formula isn't the only way to limit Medicare costs, she said. Emerson has long been an advocate for reimportation of drugs from Canada and allowing the direct negotiations on prescription pricing between Medicare and drug companies. Drug negotiations alone would save the program $156 billion, Emerson said.

"I believe there are lots of ways to control the deficit," Emerson said. "But we also can't afford to have doctors not treat Medicare patients."

rkeller@semissourian.com

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