Survey: Doctors might limit Medicare participation, even without payment cuts

Congress has voted to temporarily avert a 23 percent cut in Medicare payments to doctors that was scheduled to take effect this week, postponing the cut for another month.

But that might not be enough to keep Connecticut doctors from limiting the number of Medicare patients they see, according to a new survey by the Connecticut State Medical Society.

Fifty-five percent of doctors responding to the online survey earlier this month said they would limit the number of Medicare patients they accept or stop participating in the program altogether if Congress delayed the cut but did not enact a permanent solution to the formula behind it.

Dr. David S. Katz

Doctors have faced potential cuts in Medicare payments for much of the past decade, but this year, the threats of cuts – and Congressional action to stop them – have become more frequent.

“It becomes something that just wears you down and it erodes your confidence in the system,” said Dr. David S. Katz, the medical society president and a Milford general surgeon.

Still, the temporary fix, which passed the House Monday after passing the Senate Nov. 18, might keep some doctors from dropping Medicare or limiting the number of patients they see, the medical society survey indicated. The cut would also affect TRICARE, which covers members of the military and their families.

Had Congress not halted the cuts, 19 percent of the 360 doctors surveyed said they would stop taking Medicare and TRICARE. Another 31 percent said they would limit how many new Medicare and TRICARE patients they accept, while 28 percent said they would not see any new patients covered by those programs.

President Obama must still sign the bill to avert the cut. A statement released by the White House Monday afternoon praised the legislation and called for Congress to pass a one-year extension. It also said Obama has been seeking a long-term, sustainable solution.

The potential cut is the result of a formula known as the sustainable growth rate, or SGR. Established in 1997, it is meant to limit growth in Medicare spending, in part by linking rates paid to doctors to the gross domestic product.

For most of the past decade, the formula has been more a threat than a reality. Since 2003, Congress has overridden the potential cuts with temporary patches, which doctors came to see as expected, once-a-year events, Katz said.

But this year, the temporary fixes put off the cuts for shorter periods of time, and Congress waited longer before taking action, leaving doctors increasingly concerned that the cuts could become reality and frustrated at the lack of a permanent fix. In June, a 21 percent cut in Medicare rates took effect before Congress reversed it retroactively and raised rates by 2.2 percent.

The latest fix would mark the fifth time that Medicare payment cuts have been postponed this year.

And there’s another cut slated to take effect Jan. 1. Combined with the 23 percent cut that had been scheduled for Dec. 1, it would produce a nearly 30 percent drop in Medicare payments to Connecticut doctors, according to the medical society.

Judith Stein

Judith Stein, executive director of the Mansfield-based Center for Medicare Advocacy, said the potential rate cuts have become a problem for Medicare patients trying to access medical care. Doctors appear to be feeling both insecurity and frustration, she said, concerned about having too many Medicare patients in their practices and worried about committing to care for people without being certain they will be paid properly.

“I think that doctors are tired of having to deal with this constantly,” she said.

Still, Stein said it’s not clear how many doctors will follow through on the threat to drop Medicare or limit patients if the latest temporary fix staves off the cut. Threatening to do so is a way for doctors to push for changes, she said.

“If the cut went through, there would be a big problem,” she said. “But I’m not sure that that will happen if there’s a temporary freeze again.”

Katz said he does not expect many doctors to drop Medicare entirely as long as the cut doesn’t go through, although that might not help patients find doctors.

“You can stay in Medicare and still not see Medicare patients,” he said.

And neither Katz nor Stein expects a permanent fix anytime soon, because that would require finding a way to pay for it. A 2009 estimate by the Congressional Budget Office projected that it could cost $300 billion over 10 years to repeal the Medicare payment cuts.

Instead, Katz and Stein predicted that Medicare payment rates will remain in a sort of limbo, maintained through more temporary patches, with no change to the formula behind it.

“I think there will be a fix because who in their right mind is going to let their constituents face the potential of not having access to health care?” Katz said. “I think it won’t be cured because who in their right mind, if you’re a politician, will take that debt on?”

Two things could change that, he said: Medicare patients lobbying for a permanent change, or Congress allowing a formula-driven payment cut to go into effect.

“Eventually, like most things in the American society, things only really get fixed when it becomes a crisis for enough people,” Katz said. “Right now, physicians aren’t enough people, but eventually it’ll get fixed.”

Stein said avoiding the payment cuts should be a top priority, even if the most immediate action is short-term.

“Limping along is better than not,” she said. But, she added, until there is a permanent fix, the problem will continue.