Medicare Doctors May Limit Patients as Fee Cuts Loom, page 1

[Bloomberg) -- A 21 percent payment cut for Medicare physicians, set to begin next week, led Michael Bell to delay appointments for his elderly patients by four months.

“We don’t know what we’re getting paid this year and we need to get systems in place before the bad news,” said Bell, a 55-year-old dermatologist who practices in Murfreesboro, Tennessee, a city of more than 100,000 southeast of Nashville. The American Medical Association, the largest U.S. group for doctors, said today “many” physicians will limit patients.

Annual fee reductions beginning in 2002 were baked into a formula that Congress approved in 1997 to slow growth in government spending. Starting in 2003, lawmakers have delayed the reductions, which accumulate as a result. That creates a dilemma while President Barack Obama is promising to rein in health-care costs, said Paul H. Keckley, head of the Deloitte Center for Health Solutions, a research arm of Deloitte LLP.

“If you look at the numbers we’ll spend on Medicare, it’s the single biggest spending in health care,” Keckley, who is based in Washington, said in a Jan. 28 interview. “We aren’t zeroing in on this and finding a way to reduce costs without compromising care.”

The cost of Medicare is expected to grow 1.5 percent this year to $514.7 billion, or 1 out of every 5 dollars spent on health care in the U.S., according to forecasts issued Feb. 4 by the Centers for Medicare and Medicaid Services, a U.S. agency. Medicare spending would grow 5.1 percent without the cut, the agency said. About 40 million people in the U.S. are 65 and older, the main group served by the health-care program.

Temporary Fix

The U.S. House of Representatives voted yesterday for a one-month delay in the reductions as part of a $10 billion employment bill that also would help the jobless buy health insurance. The legislation, which the Senate may take up next week, would give lawmakers more time to debate the fee cuts.

Medicare “has no discretion” to avoid the cuts, set for March 1, said Ellen Griffith, a payment specialist at Medicare, in an e-mail. The U.S. average fee for a “mid-level” office visit is $65.67, and Medicare pays 80 percent of the cost.

The uncertainty “makes it very hard for physicians to plan ahead, and some providers will have a cash-flow problem,” said Mark B. McClellan, a physician and health-care analyst at the Brookings Institution, a policy research foundation in Washington.

“Most physicians probably won’t close their doors to Medicare patients immediately, but they’ll have concerns that they can’t continue operating that way,” said McClellan, a former chief of Medicare and the Food and Drug Administration.

‘Fallen Behind’

Bell, the Tennessee doctor, said in a phone interview yesterday that he reduced his Medicare appointments 20 percent to brace for the cuts. Even if Congress steps in, Bell says, Medicare pays too little.

“For the past few years, we’ve had only a zero to maybe 1 percent raise in fees, while our expenses go up at least 4 to 5 percent each year,” Bell said. “So we’ve fallen behind, and that’s about as much as we can handle.”

Bell says he now gets about $34.52 for an office visit from Medicare for his patients.

The Mayo Clinic, praised by Obama as a national model for efficient health care, said it would stop taking Medicare patients at its primary-care clinic in Glendale, Arizona, starting Jan. 1, saying the U.S. government pays too little.
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As I was waiting to see my doctor yesterday I noticed the ill mood of the doctors and nurses in the office.

I also overheard a telephone conversation my doctor was having with a salesman.

It wasn't difficult to figure out the problem.

As soon as doctor walked into my little closet of an examination room I spoke up and said "Damn the government, I have insurance. Are they trying to kill us doc?".

He said if the public only knew how bad our economy was we would panic.

After the doctoring and recording of his findings I was shocked to learn patients are now given a defining number. A number one is no insurance and self pay. Number 2 is Medicare patients. Number 3 is patients with private insurance. I was given a number 3.

I am mad as hell and so are our doctors. People are not going to be receiving proper medical care and will die due to the ignorance and greed of our government .

My line has been drawn in the sand. This was the final me.