Medicare cuts threaten a crisis in care

2/15/2003

Senior citizens in Ohio may soon have a difficult time finding physicians who are willing to accept new patients on Medicare.

For those who don't have access problems, they may suddenly find that their physicians have even less time to spend with them and that additional, free services that were once offered are no longer available.

This terrible situation has been brought about by several factors, including a massive mistake made by the government agency that runs the Medicare system and the failure by Congress two years in a row to remedy the error and fix other problems related to how Medicare reimburses physicians for treating Medicare patients.

Should patients and physicians be punished because of administrative blunders and political ineptitude? The answer, clearly, is no.

A year ago, the federal government reduced the amount it pays physicians for treating Medicare patients by more than 5 percent on average. That may not sound like much, but when coupled with liability insurance premiums that have doubled and tripled for many physicians, and the continued escalation in the cost of running a medical practice (increases that are well beyond what most other industries have experienced), it's a substantial cut.

In 2003, physicians are facing another reimbursement reduction of more than 4 percent on average, with further cuts scheduled for 2004 and 2005.

If something is not done, Medicare reimbursements will be at 1991 levels by 2005. This is in spite of a nearly 40 percent increase in the cost of providing services over the same time period.

The end result is that physicians have to make tough choices. For some, it means sacrificing purchases of new technology such as electronic medical records or new devices that will improve the quality of care. For others, it means no longer taking Medicare patients or, for some older physicians, early retirement.

In the end, both patients and physicians lose. The situation is untenable at best and catastrophic at worst.

Older patients are already feeling the impact of these reimbursement reductions. A recent survey by the Medicare Rights Center found that access problems for Medicare patients have increased since the cutbacks in physician payments took effect.

Moreover, it is becoming nearly impossible for physicians to continue providing the same level of high-quality care that most seniors depend upon and deserve. The cuts come at a time when many physicians' costs are rising precipitously, particularly in the areas of employee salaries and health benefits, medical liability insurance premiums, and advanced technology.

In terms of heart disease, older persons are especially vulnerable in this environment. They are the ones most likely to have asymptomatic or “silent” cardiovascular disease, and they are now at greater risk because they may not have timely or adequate access to prompt and accurate diagnosis and proven therapies.

At the same time, workforce studies are beginning to show that there will not be enough cardiologists to treat all of the patients with cardiovascular disease - a growing population because of the obesity and diabetes epidemics.

Our older patients are not the only ones at risk. Many physicians act as the voluntary “safety net” for the millions of patients with no or inadequate health insurance. According to a recent study by the Center for Studying Health System Change, financial strains caused by reduced reimbursement is forcing physicians to stop providing charity care and reduce the number of Medicaid patients they see. In addition, many physician practices offer their patients free ancillary services such as heart failure and blood pressure clinics, preventive care services, nutritional counseling, and prescription drug education.

These services help patients better manage their conditions and, in the process, save money by improving adherence to treatment regimens and reducing hospitalizations.

Restricted or untimely access to physicians will only be exacerbated with the aging baby boomer generation. Take heart disease, for example. While mortality rates have fallen, it is still the number-one killer in the country. Of the tens of millions of heart disease sufferers in the United States, about 1 million people are hospitalized for heart failure each year, a number that will only increase.

Physicians and patients cannot afford to be silent about this looming crisis.

The stability of our medical system relies on ensuring that patients continue to have access to the best quality care possible, whether it's an office visit with their physician or a free blood pressure clinic.

Dr. Fraker is a cardiologist, medical director of Medical College of Ohio Hospitals, and president of the Ohio chapter of the American College of Cardiology.