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Medicare doctors await annual dose of delay by Congress

By ANA RADELAT CT Mirror

Publication: The Day

Published December 03. 2012 4:00AM
Reimbursement 'fix' not a permanent solution to the rising cost of care

Washington - Unless Congress acts soon, the New Year will bring plenty of misery for Connecticut's doctors.

On Dec. 31, a temporary measure known as the "doc fix" will expire, resulting in a 30 percent decrease in fees to all doctors who treat patients through Medicare, the government-run health program for the elderly, and active and retired members of the military who are covered under the government's TRICARE program.

"This would basically result in a collapse of our ability to provide care," said John Foley, a cardiologist in Norwich and president of the Connecticut State Medical Society.

Foley said that 37 percent to 40 percent of Connecticut's doctors would stop treating Medicare and TRICARE patients if their fees are slashed.

That would affect many in the state. Connecticut has more than 563,000 Medicare beneficiaries and more than 50,000 active and retired members of the military and their families who are covered by TRICARE.

The perennial panic over the "doc fix" is the result of a formula created by Congress in 1997 that calculated increases in Medicare and TRICARE physician payments on the overall economic growth of the nation. But there's one big problem with this approach: Health care costs have outpaced the nation's economic growth, leaving a multi-billion-dollar shortfall in payments to doctors.

So every year, and sometimes every few months, Congress must appropriate additional money to pay doctors.

Foley, and most fellow physicians, are frustrated by Congress' short-term solutions. They say it's hard to run a business with the uncertainty.

"Congress ... tends to kick the can down the road, and we don't want another six- or 12-month [doc fix]," Foley said.

The blame, Foley said, is "poor leadership in Congress."

American Medical Association Executive Vice President James Madara called the short-term solutions a "zombie fix."

"It keeps on coming back from the dead each year in worse and worse form ... and you go through that year after year, and you're uncertain, it puts practices at risk and frankly puts our elderly at risk," he said.

U.S. Rep. Joe Courtney, D-2nd District, and other lawmakers are pressing for a permanent solution to the problem. They are backing a bill, introduced by Rep. Allyson Schwartz, D-Pa., that would freeze doctors' pay for one year, then give them annual raises for the next four years.

During that time, the Centers for Medicare and Medicaid Services would have to find a new way to pay doctors. Physicians would be penalized for ordering unnecessary tests and procedures for their patients under the plan. But the cost of the permanent doc fix would be high - as much as $300 billion.

Courtney and other backers of the permanent fix say the money could be found in funds appropriated for the wars in Iraq and Afghanistan that are likely to be left unspent as those conflicts wind down and troops are withdrawn.

Trouble is, there's a lot of competition on Capitol Hill for that pot of money.

Backers of the bill are also hopeful the permanent solution to the doctors' problems can be part of a grand compromise Congress must reach to avoid a "fiscal cliff" at the end of the year.

"The question is, can we get people to focus on this intelligent approach?" Courtney asked.

There will be few other chances to approve legislation in the current lame duck session of Congress. But some say that Congress' bitter partisan fight over spending and taxes needs no additional controversy.

Meanwhile, doctors such as Foley, who works in a practice that employs 40 people and says that at least half of his patients are on Medicare, are concerned about small practices like his being able to stay in business.

"As a state we are still lucky enough to have many small- and medium-sized practices," he said. "But for how long?"

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