May 3 2010
American Medical News reports on doctors' frustrations with the Medicare program and looks at the practice of Juliette Madrigal-Dersch, an internist in Marble Falls, Texas, who "decided to see Medicare patients only on a private-contracting basis. That means neither she nor her patients can claim any payment from Medicare. It also means she can charge what her services actually cost, not just what the government says it will pay. She also can choose not to charge anything, as is her policy for patients age 90 and older." Her story is an unusual one. "Relatively few doctors sever ties with Medicare altogether." But physicians are tiring of the cycle of facing dramatic Medicare pay cuts only to be spared by lawmakers when they apply short-term fixes. "Many physicians who aren't thinking of dropping out of the system completely are at least mulling a change to their Medicare participation status. Some have stopped accepting new Medicare patients" (Silva, 5/3).
The Greenville News: "Senior citizens could have a harder time finding a doctor, the head of the American Medical Association warns, unless Congress fixes a funding formula that pays physicians [at] 2001 levels. According to the AMA, South Carolina has 15 practicing physicians per 1,000 Medicare beneficiaries compared with the national average of 19, and four of 10 are 50 or older. Doctors in the state and around the country are pushing to get 1 million signatures on a petition to ask Congress for a permanent fix of the Medicare physician payment system. The current payment formula was part of the Balanced Budget Act of 1997, which set growth rates that were too low, according to the American Medical Association. In the ensuing years, that that resulted in reimbursement cuts, though most were averted by Congress" (Osby, 5/3).
The Associated Press: "President Barack Obama's health care overhaul law cuts about $500 billion from Medicare in the next 10 years and spends most of that to cover uninsured workers and their families. Democrats say retirees have nothing to fear because those cuts will help push off Medicare's insolvency until 2029 — a full 12 years from current projections. … Sorting out what the overhaul means for Medicare's finances can be confusing. Federal accounting practices allow the health program for people 65 or older to get a credit — an IOU — for savings that actually will largely get spent to cover younger generations." The AP answers various questions about changes to Medicare and notes: "But make no mistake — closing Medicare's future funding gap will be harder now that some of the easier sources of savings have been tapped to finance the health care bill" (Alonso-Zaldivar, 5/1).
North Bay Business Journal: "Facing up to $10 million in cuts to Medicare reimbursement, hospice leaders had hoped the passage of the federal health bill in March would blunt the impact of such a sharp hit. Although the bill lessened the cut to $7.8 million, hospice and palliative care will still be significantly affected, North Bay end-of-life care providers said. Despite the decrease in Medicare funding, which most hospices are heavily reliant upon given that they traditionally serve patients over 65 years of age, some provisions of the bill will be beneficial, said Kitty Whitaker, chief operating officer of Hospice by the Bay in Larkspur. ... In 2010, hospice care faces a 3.5 decrease in Medicare reimbursement with incremental cuts expected over the next seven years, Hospice by the Bay CEO Sandra Lew wrote in an annual report for 2008-2009, adding that a reduction in services could arise from such cuts" (Verel, 5/3).
 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.
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An Arm and a Leg: The Medicare episode