Are you a Medicare patient, or nearing the age to become Medicare eligible? Are you and your family covered by Tricare, the military's insurance coverage? Do you have parents, children or friends who fall into these categories? You should be concerned. Physicians who accept Medicare and Tricare patients are being forced to limit the number they can serve because of the low reimbursement rate. The American Academy of Family Physicians reports 13 percent of family physicians don't participate in Medicare at this time and as many as 30 percent limit Medicare patients in their practice. These numbers are expected to double in coming years if changes are not made. Medicare was created in 1965. Tricare rates are based on Medicare rates. The government began limiting physicians' fees in 1975. In 1988, Congress established a Medicare Fee Schedule for each procedure and enacted the Sustainable Growth Rate (SGR) that sets annual spending targets. The SGR establishes a formula to decrease reimbursements to physicians when actual expenditures exceed the target. Note that it is doctors' fees that are decreased — not those of hospitals, medical equipment suppliers, pharmacies, or any other component of the health care delivery system. Congress has repeatedly delayed fixing the SGR formula — extending the deadline 10 times in eight years, sometimes for only a month or two and often so "close to the wire” that claims have been held for days or weeks by the government waiting for the law to pass, leaving reimbursements in turmoil. On June 1, doctors saw their fees drop 21 percent, which has now been reversed by passing a six-month patch that increases the reimbursement rate by 2.2 percent through November. If another "fix” is not approved, a 21.2 percent payment cut will take effect Dec. 1. In 2008, Medicare paid physicians only 78 percent of private insurance, on average. Mandates and reporting requirements have mushroomed, requiring an increase in numbers of staff and significant investments in training. Physicians will soon be required to implement electronic prescribing and electronic medical records — a huge investment. Small practices will be hard-pressed to meet these requirements and may be forced to close. Physicians choose medicine to care for people. Many also provide some charitable care, often working in free clinics or accepting specialty referrals from the clinics. But they must meet payroll and support their families. They graduate medical school with huge student loans, often exceeding $100,000. This time, it is Congress that needs to stop the bleeding and enact a sensible payment formula to keep doctors in their offices. This affects all of us. Baby boomers will soon be Medicare patients. Let your representatives and senators know how you feel and tell them to maintain access to quality health care for our seniors and our military. Bookman is president of the Oklahoma County Medical Society.
Congress has repeatedly delayed fixing the SGR formula — extending the deadline 10 times in eight years.