Medicare Cut 21%

Doctors, Patients, Staff Members feel pain of 21 percent Medicare Cut

By Stacey Singer

Updated: 9:29 p.m. Monday, March 1, 2010

Posted: 6:24 p.m. Monday, March 1, 2010

Doctors who treat Medicare patients said they continued appointments as usual Monday, despite a 21 percent cut in their reimbursement that went into effect because of a Congressional stalemate.

But if those Medicare cuts stick, all bets are off, doctors cautioned.

Delray Beach cardiologist Dr. Louis Snyder said his group of four physicians had laid off five people last week because of a combination of declining Medicare reimbursements and fewer patients. Expect to be put on hold more often and to have phone calls returned more slowly, he said.

Each year since 2002, Medicare has been slated to automatically cut what doctors are paid, based on a formula called the sustainable growth rate. Each year, when those cuts were about to take effect, Congress has bent to industry pressure and undone the cuts, leaving them to pile up for another year.

But this year, seven years of Congressional avoidance has hit doctors all at once, because of a dramatic stance on the deficit taken by Republican Sen. Jim Bunning of Kentucky.

Protesting unchecked spending, Bunning refused last week to allow a vote on a $10 billion bill that lacked a mechanism to pay for it. In the process, his objections brought Medicare Part B reimbursements to the point of crisis. Medicare Advantage plans were not affected.

The American Medical Association predicted dire problems for seniors if the stalemate isn't fixed, and didn't limit its blame to Bunning.

"The Senate had over a year to repeal the flawed formula that causes the annual payment cut," said AMA President Dr. J. James Rohack.

The AMA predicted many doctors will limit how many Medicare Part B patients they're willing to treat if the cuts stand.

"Seniors should be very concerned about how the Senate's inaction will impact their ability to see a doctor,"Rohack said.

At Boca Raton Community Hospital, cardiologist Dr. Stephen Babic said doctors have planned a protest of the Medicare cuts for Wednesday.

"Doctors are working today and they don't know what they are going to be paid," Babic said. "All the doctors here are saying if you cut us 20 percent we can't make payroll, we can't pay our overhead, we can't keep the doors open."

Health providers in Palm Beach County said they had been facing tough times even before the cuts, as unemployment has risen and insurance rates have fallen.

Hospital owner HCA said it laid off staff at three Palm Beach County hospitals last week, including 14 from JFK Medical Center in Atlantis, 13 from Palm West Medical Center in Loxahatchee and eight from Columbia Hospital in West Palm Beach.

"In 2009 we did $43 million in charity and uncompensated care," said JFK Medical Center Marketing Director Nicole Baxter. "I don't think this is necessarily a Palm Beach County trend. People are putting off elective procedures, and unemployment is up."

Baxter said the company is adjusting to become more efficient. Doctors offices are doing the same.

Snyder said cardiologists were especially hard hit because in January, Medicare cut what it paid for certain diagnostic tests like echocardiograms.

In the expectation that Congress will pass a fix quickly, a spokesperson for the U.S. Centers for Medicare and Medicaid Services in Washington said the agency told its contractors to hold claims from March 1 for 10 days. But if Congress doesn't act by then, "we are constrained to follow the statute," and cut the payments, the agency spokeswoman said. "We have no choice."

The prevailing view of cardiologists as wealthy is "historic," Snyder said. In the late 1980s, when he started practicing, Medicare would pay him about $1,000 for a cardiac catheterization. Last month, he was paid $185 for the same procedure. If the Medicare reimbursement cuts stand, Medicare will pay him less than $150 for procedures done after March 1 this year. As it happens, better drugs and cholesterol control mean fewer cardiac catheterizations need to be done in the first place, and $100 office visits only go so far.

The job cuts at the Cardiology Center have hit the front desk and some nursing positions. Patients may have to wait longer for their calls to be returned, and their labs will be reviewed by one less person, with the computer's flagging system taking over, Snyder said. Long run, he predicts cardiologists will work for a few large corporations and patients will feel like numbers.

"Our patients enjoyed a very, very high level of attention and care. But the cost of our care was too expensive for the system," Snyder said. "Nobody can sustain this huge a cut in income."

stacey_singer@pbpost.com

Palm Beach Post Staff Writer