May 25, 2018
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Congress must find a way to pay Medicare doctors

Casanova | MCT
Casanova | MCT
300 dpi Hector Casanova color illustration of a sick patient coughing while his doctor can't examine him due to the gulf created by a gap in the person's health insurance coverage. The Kansas City Star 2010

With BC-HEALTHCARE-GAP-ADV21:KC, Kansas City Star by Alan Bavley

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By Nancy Kelleher and Gordon Smith, Special to the BDN

This time of year, most people are thinking about spending time with family and friends, enjoying the holidays and making resolves for the new year. But unless Congress acts quickly, many seniors may start the new year with a resolution that is hard to achieve: finding a doctor to treat them.

Under a flawed payment system now in effect, physicians who treat patients on Medicare will face a potential pay cut of 25 percent by Jan. 1. If that happens, many doctors will drop out of the Medicare program or stop taking new Medicare patients. Any senior fortunate enough to find a doctor who still accepts Medicare may have to travel farther to be treated or wait longer for an appointment.

In 1997, Congress created a system known as the Sustainable Growth Rate to pay doctors in Medicare. This system was originally designed to hold down physician costs by setting limits on spending. However, the system underestimated how much Medicare would spend on tests and procedures for seniors, which caused physician fees to be reduced to stay within spending limits.

For almost 10 years, each time the deadline has come up to fix this system, Congress has avoided finding a cure and instead treated it with a temporary remedy. Each time it has done that, the problem has grown larger — and more expensive to fix. Now, if Congress fails to block the 25 percent cut, Medicare won’t be able to pay doctors what it costs to care for seniors.

A physician payment cut in Medicare would hit Maine especially hard. Our state has a higher-than-average proportion of Medicare patients. In fact, there are more than 262,000 Medicare beneficiaries in Maine, and they are not the only ones who would be affected by this cut. More than 42,000 Mainers who have served in the military also would be in jeopardy, since physician reimbursement rates for Tricare also are subject to a reduction come January if a solution is not found.

Mainers worked hard over many years to earn their benefits from Medicare, a program they paid for out of their paychecks week after week and year after year. People who are in the program now count on the security they get from seeing the doctors they trust. Those who are not yet old enough are hoping their current doctors will continue to care for them once they get on Medicare or that they at least will be able to find a good doctor who will accept them.

We know Mainers expect Congress to act, to meet its responsibility and to keep doctors in the Medicare program. A recent AARP survey, in fact, shows that more than eight in 10 members in Maine, whether Democrat, Republican or independent, are concerned that a Medicare pay cut could block their access to doctors. A similar proportion of our members also supports their senators working to stop this cut: 82 percent of members across party lines said they would look more favorably on their senators if they fought to protect Medicare payments to doctors. So for them, Congress must take responsibility.

AARP and the Maine Medical Association are asking that Congress act during this lame-duck session to prevent seniors from losing their doctors and future retirees from having to give up the doctors they trust. We also are asking that Maine residents contact their senators and congressional representatives and urge them to fix this system — at least for one more year — so seniors can have the security they’ve earned. We know the economy is weak and that this may not be the right time to find the cure, but this certainly isn’t the time to abandon treatment.

Nancy Kelleher is state director for AARP Maine. Gordon Smith is executive vice president of the Maine Medical Association.

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