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Senior Citizen Politics
Doctors 'Disgruntled' And Frustrated By Battle Over Medicare Pay Cuts
Congressional negotiators agreed today to delay the huge cut in Medicare pay rates for physicians until next year.
By Julie Rovner
Agree on One-Year Delay in Cut of Medicare Pay to Doctors
Feb. 17, 2012 - The Associated Press reports today that congressional negotiators have
agreed on a $144 billion package that, among other things, extends the 27 percent cut in
reimbursements for doctors treating Medicare patients.
Read the complete AP Report
Feb. 17, 2012 - A looming 27.4 percent cut in Medicare reimbursements likely won't happen. But next year, any cuts could be greater.
The good news for the nation's doctors and the millions of Medicare patients they care for is that assuming
everything goes as planned, the
27.4 percent cut in reimbursements that would have taken effect March 1 won't.
The bad news? The fix included in the deal to extend the
payroll tax holiday isn't permanent. It only extends to the end of the year. And then, if Congress doesn't act again, the cut it is
expected to be will be in the neighborhood of 32 percent.
That's leaving doctors in a continuing state of uncertainty.
"Disgruntled is probably just too soft of a term for this," says Robert Wah, a reproductive endocrinologist at the
National Institutes of Health and the Walter Reed Army Medical Center. He's also Chairman of the Board of Trustees of the
American Medical Association. "It's really devastating to try to run an office in this environment."
Wah says doctors have been through this exercise before waiting to see if Congress will stop a scheduled Medicare cut.
Too many times.
"In 2010, Congress did this to us
five times," he said. "There were five patches put in place, and a couple of times they actually waited until after the deadline," which
meant payments were delayed.
Disgruntled is probably just too soft of a term for this. It's really devastating to try to run an office in this
- Robert Wah, reproductive endocrinologist, and chairman of the board of trustees, American Medical Association
Wah says many physicians are also small businesses. So the uncertainty of knowing how much or in some cases whether
they're going to be paid to see their Medicare patients, is more than just an inconvenience. "Because they have to continue to pay their rent
and their insurance and their electric bill and the salaries of the people that work in their office," he says.
Until now, the public hasn't had a lot of sympathy for the plight of America's doctors and their Medicare woes. Despite
their complaints, doctors still
earn a lot more than the average American. And
surveys showed that most doctors continued to treat Medicare patients.
This problem with how Medicare pays doctors is the result of a
funding formula enacted in 1997 that's since gone awry. It affects many members of the military, too, because rates for the
TRICARE health program are
tied to those for Medicare.
But over time it has been gradually eroding what doctors earn to care for those patients. That's because while Congress
mostly hasn't let the scheduled cuts take effect, it also hasn't given doctors a raise, either. The result, says Wah, is "there's now a 20
percent gap between... the cost of taking care of the folks in the Medicare and TRICARE system and the lack of increase in our fee schedule."
Now that's starting to have an impact on patients, says Paul Ginsburg, president of the
Center for Studying Health
System Change, a health research think tank. Ginsburg says most Medicare patients aren't having trouble getting care because they're not
changing doctors. But with many doctors
not taking new Medicare patients, there is starting to be an access problem.
"Someone who needs another doctor, either because they've moved, or their doctor is retired or they just don't like their
doctor anymore; those are the people bearing the brunt of whatever access limitation we have," Ginsburg says.
But Ginsburg says he's also worried about something else the increasing gap in pay between primary care doctors, like
family practitioners, and internists and specialists. Particularly now, he says.
"We really are looking to
primary care physicians to play a bigger role, to coordinate care, to manage chronic disease, and not just to do piece work," he says. But
"at the same time we're envisioning a changed role...we're making primary care much less attractive."
Those changes to the health delivery system are the result of the 2010 health overhaul. And it did include some
payment increases for primary care doctors in Medicare. But it didn't fix the overall doctor payment problem largely because it cost too
And while there were a few hints that Congress might be getting ready to fix it using unspent funds from the wars in Iraq
and Afghanistan, that didn't happen. Which is why Wah and his colleagues are getting increasingly frustrated.
"Our organizations are committed to helping Congress develop better ways to pay physicians and deliver care to patients,"
joint statement from the American Academy of Family Physicians, American College of Physicians, American College of Surgeone, and American
Osteopathic Association. "(B)ut Congress must do its part and enact permanent repeal of the (current funding formula) before 2012 comes to a
>> To comment on this story, read other comments are get updates,
click here to NPRs Health Blog, SHOTS.
Note: This blog was originally posted on NPR on Feb. 16, 20-12
information is from
kaiserhealthnews.org with permission from the Henry J.
Kaiser Family Foundation. You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign up
for email delivery. © Henry J. Kaiser Family Foundation. All
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