Florida Health News

Florida doctors in D.C. protest Medicare pay cuts

 By Susan Jaffe
4/4/2008 © Florida Health News
WASHINGTON – Among a group of Winter Park internists who fill in for each other on weekends, three have left traditional medical practice in the past four months. One went to the VA, one to a hospital and the other stopped accepting insurance. But of those remaining, Dr. Cecil Wilson won’t quit without a fight.

Wilson

So Wilson came to Washington this week to persuade Congress not to cut payments to doctors under Medicare, which covers 75 percent of his patients. He joined nearly 1,000 members of the American Medical Association, including about two dozen from Florida, who held a rally outside the Capitol before making House calls. Some wore white coats and stethoscopes as they entered Senate and House of Representatives offices for a familiar ritual: protesting Medicare’s scheduled pay cut for doctors. This time it’s 10.6 percent, due to take effect July 1.

Like other times they’ve made House calls, Wilson said they encountered little opposition to the idea of canceling the reduction in pay. Wilson said everyone in Congress understands that the cuts would “have perverse effects on the payment to physicians and the access to care for senior citizens.”

It’s that rare issue on which both political parties agree. “If the recent past is any indication, Congress won’t allow any cuts,” said Bryan Gulley, a spokesman for Florida Sen. Bill Nelson, a Democrat. “In fact, lawmakers haven’t allowed any since 2002.”

But Wilson, who has been in private practice 37 years and is a member of AMA’s board of trustees, said he had little hope that the payment formula that can trigger cuts will be fixed before July. He expects Congress will postpone the cuts again.

So does Michael Wasylik, a Tampa orthopedic surgeon who has logged a lot of hours lobbying on the issue. “They can do something about it -- they just won’t,” he said. “This has been going on for years and Congress just does nothing.”

Why? The daunting complexity of the issue is one reason, said Ken Lundberg, spokesman for Florida Sen. Mel Martinez, a Republican.

Money is another, he said. Replacing the current payment formula with one that rises with medical inflation would cost an additional $262 billion by 2017, the Congressional Budget Office reported last year.

Nelson’s spokesman offered a third reason for the delay: politics. “You have razor-thin (majority) margins in the Senate,” Gulley said. “And there hasn’t been much of an appetite by the leadership -- which has changed three times since we’ve been here -- to take up major Medicare reform. That’s a political reality.”

The physician payment formula has been put off every year since it was enacted in 1997. In some years, including the first half of this year, Congress even gave doctors a small raise

But maintaining the current pay rate just through the end of the year would cost $2.1 billion, according to a government report. Budget “pay-as-you-go” rules that are now in place require that any expenditure must be offset by reductions in other areas of spending.

Sen. Martinez supports a temporary “patch” but wants a permanent solution, said Lundberg. Martinez has made a series of speeches recently in Florida calling for an attack on Medicare fraud, which he said wastes as much as $60 billion a year.

Nelson, who met Wednesday with the current and incoming presidents of the Florida Medical Association, has asked his staff to review legislation proposed by Michigan Sen. Debbie Stabenow, which would continue this year’s payment rate and provide a small increase in 2009, delaying any cuts for 18 months.

Tampa Rep. Kathy Castor would find money for doctors by cutting payments to private Medicare managed-care plans, which government and independent reports have said are overpaid. Castor wants to “put that money back where it belongs -- in Medicare, so more seniors can see their doctors,” said spokeswoman Agustina Guerrero.

Castor and other Democrats tried to include the pay fix in the bill that shored up the children’s health insurance program, but eventually dropped it along with other Medicare changes to garner Republican votes and the president’s signature.

So far, a majority of Medicare patients still can find a doctor who’ll accept their coverage. A 2007 survey showed 75 percent never had to wait for a routine appointment, according to a report last month from the Medicare Payment Advisory Commission, an independent congressional agency. Of those seeking a specialist, 85 percent had no difficulty finding one.

The commission’s analysis of 2006 Medicare payment claims showed the number of physicians treating Medicare patients continued to rise, keeping pace with the growth in the Medicare population.

But that was in 2006. Wasylik, in Tampa, said insufficient Medicare payments have already hurt Florida. He said utility bills, rent, staff salaries, and other costs of maintaining a practice continue to go up, but Medicare payments stay the same.

“Many of the primary-care doctors are not taking new Medicare patients, and that’s right now,” he said. “It can’t go on this way – obviously.”

Florida Health News Washington correspondent Susan Jaffe can be reached at susanjaffe@earthlink.net.