For many Floridians, including our elderly and disabled citizens who depend on the program for care, Medicare is a lifeline. For Florida physicians, Medicare represents a cycle of uncertainty and an access-to-care crisis for some of our most vulnerable patients.
Now, the Joint Select Committee on Deficit Reduction has a chance to fix the problem that is crippling Medicare: The Sustainable Growth Rate (SGR) formula, which determines Medicare reimbursement for physicians. Doctors have faced the threat of severe payment cuts for more than a decade. Congress has only delayed these cuts, and a lack of confidence in the program’s viability has caused many physicians to stop treating Medicare patients.
People on Medicare already have a difficult time finding doctors, and failure to fully repeal the SGR makes the situation worse. Over time, the cost of permanently fixing the problem increases significantly.
The Florida Medical Association is urging the Committee to seize this unique opportunity to do away with the SGR for good. The Committee must submit its recommendations by November 23, 2011.
How Does the SGR Affect Patients?
Even by Medicare’s conservative measure, physicians’ cost-of-care expenses have risen 22 percent since 2001. In contrast, Medicare payments to physicians have increased only about one percent in that time. When the payment rate is adjusted for inflation, it has actually decreased—further illustrating the challenge for physicians.
Most Florida physicians are considering completely “opting out” of Medicare because they simply can’t afford to pay more out of their own pocket than they are reimbursed for. This will result in Medicare patients experiencing major difficulties finding a physician to treat them and a tremendous increase in the wait to get an appointment with a physician. Seriously ill patients will be forced to seek care in emergency rooms, which is ultimately much more expensive and will exacerbate emergency room overcrowding.
The American Medical Association has designated Florida one of 20 “access hot spots,” where patients already have trouble finding a physician. Currently, the state has only 15 practicing physicians per 1,000 Medicare beneficiaries.
What Can We Do?
In May 2011, the Medicare Patient Empowerment Act was filed in Congress. The legislation, which originated from a Florida resolution to the American Medical Association House of Delegates, establishes a Medicare payment option for patients and physicians to freely contract for Medicare services.
Under current law, a Medicare beneficiary who chooses to see a physician who does not accept Medicare essentially loses his or her Medicare benefits because there is zero reimbursement for the cost of that care. The Medicare Patient Empowerment Act would allow seniors to keep their Medicare benefits, see the physicians of their choice, and privately contract with their doctors outside of the Medicare program without being deprived of their rightful financial assistance.
There would be no penalty for entering a fee-for-service contract, and the physician or practitioner would continue as a Medicare participant or non-participant with all other patients not under contract. In this way, the bill protects physicians and practitioners. The bill also ensures that a patient would not be held responsible should any fees exceed those specified in the contract, and no contract may be entered in an emergency situation. In this way, the bill protects patients.
The FMA has launched www.ItsMyMedicare.org to educate patients and physicians and encourage them to take action. The best way to do this is to contact U.S. Senators Bill Nelson and Marco Rubio and ask them to urge their colleagues on the Joint Select Committee on Deficit Reduction to fully repeal the SGR once and for all.
The FMA believes that repealing the SGR is the only responsible solution, and it is critical in ensuring that Medicare patients can find doctors when they need medical care. Please support this effort by visiting www.ItsMyMedicare.org and encouraging the Committee to repeal the SGR permanently.
Ralph J. Nobo, Jr., M.D., Bartow
Vice President of the Florida Medical Association
Board of Trustee member, Polk County Medical Association
