Many doctors may limit Medicare patients after next year’s proposed payment cuts

AMA survey finds 59% of respondents will leave medical practice, if proposed cuts occur by 2016.

Issue: August 2007

A new American Medical Association survey reveals that 60% of physicians said that they would limit their number of new Medicare patients and 14% would prefer to leave patient care if a 10% physician payment cut is enacted next year.

In an on-line survey of nearly 9,000 physicians, the American Medical Association (AMA) also discovered that 40% of respondents reported that they would limit their number of current Medicare patients and 54% would decrease their staff with the 10% payment cut slated for 2008. Moreover, physicians face nearly 40% in total cuts over the next 9 years.

If these subsequent cuts are enacted, 68% of respondents stated that they would limit the number of their current Medicare patients and 59% said that they would leave patient care in that time frame.

Jack M. Bert, MD
Jack M. Bert

“When the cut takes place on January 1, 60% of physicians tell the AMA they will be forced to limit the number of new Medicare patients they can treat,” the AMA board chair, Cecil B. Wilson, MD, said during a press briefing. “And over 9 years, the cuts are expected to grow about 40% while the cost of caring for patients rises 20%. By the time this happens, Medicare as patients now know it will be a distant memory.”

Frightening situation

The survey also found that two-thirds of respondents said that they will put off practice investments such as health information technology and the same percentage noted that they would refer difficult cases or stop offering specific services under the 10% cut. In addition, 58% said that they would stop nursing home visits and 57% would stop rural outreach services.

Orthopedics Today section editor, Jack M. Bert, MD, called the situation frightening. He said that annual increases in the consumer price index and overhead costs coupled with dropping reimbursement and salaries make it difficult for any physician group to treat a significant number of Medicare patients. He noted that recent legislation attempting to limit physician ownership of ancillary services also increases the financial pressure on physicians and often, legislators only hear the payer’s side of the story.

“We are being bullied and there is nothing we can really do about it except become more proactive politically,” Bert told Orthopedics Today.

AMA requests

“We’re being bullied and there is nothing we can really do about it except become more proactive politically.”
— Jack M. Bert, MD

The AMA is asking Congress to halt the cuts and follow MedPAC’s recommendation of a 1.7% payment update for 2008. Many knowledgeable observers expect Congress to turn around the planned reimbursement reductions, as it has for similar proposals in recent years.

But even if provided with a reprieve on the issue once again, the pressures for cost containment in Medicare are mounting, and rejecting planned cuts today makes even bigger cuts likely later, they say. Wilson also noted that the government spends 12% more on Medicare Advantage plans than patients in traditional Medicare.

“We are calling for Congress to institute financial neutrality between Medicare Advantage and traditional Medicare,” Wilson said. “The government estimates that this will save Medicare $65 billion over 5 years. That is money that can be used to help stop steep Medicare physician payment cuts that will harm senior’s access to care. With Medicare, Congress made a solemn promise to provide health care to America’s seniors. That promise is compromised by steep cuts to physicians at a time when their services have never been needed more.”

For more information:
Jack M. Bert, MD, can be reached at 17 W Exchange St., 307 Gallery Medical Building, Saint Paul, MN 55102; 651-223-9204; bertx001@tc.umn.edu.
Cecil B. Wilson, MD, AMA board chair, can be reached at American Medical Association 515 N. State Street Chicago, IL 60610; 800-621-8335.
Reference:
Member Connect Survey: Physicians’ reactions to the Medicare physician payment cuts. American Medical Association. June 2007. Available at: www.ama-assn.org