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Federal health programs left in limbo
Congress must act to avoid reduction in Medicare, Tricare payments to doctors
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Doctors nationwide are still waiting to learn the fate of their payments for treating Medicare and Tricare patients.

The U.S. Congress has little more than a week to determine if these payments will be reduced by 25 percent over the next year.

"Medicare and Tricare have a fee schedule they pay for services that their patients receive," said Dr. Frank McDonald, a neurologist with The Longstreet Clinic in Gainesville.

"Without any further reduction, Medicare payments are generally one of the lower payments that doctors receive."

McDonald is also the vice speaker of the house of delegates for the Medical Association of Georgia.

According to the American Academy of Family Physicians, the Tricare fee schedule is based upon the Medicare rates.

Both Medicare and Tricare are government-funded health insurance plans. Tricare is for members of the military and their dependents. Medicare covers the elderly, individuals with certain disabilities and people with end-stage renal disease.

The pending cuts are being necessitated by the Sustainable Growth Rate formula.

According to the American Medical Association, the SGR is based on a number of factors, including Gross Domestic Product growth and estimated changes in beneficiary enrollment. According to the AMA, one thing that isn't taken into consideration is the actual cost incurred by physicians to provide a service.

"The SGR formula was created so that if Medicare spending did not come under control, (Congress) would start cutting expenditures. One of those was reimbursements to physicians," McDonald said.

"Every time that the cuts have come up, Congress has postponed the cuts for physicians. The cuts didn't disappear, they've just been adding up, so now we're looking at a very large reduction."

If no action is taken, payments to doctors are set to be reduced by 23 percent on Dec.1
Before Congress adjourned for it's holiday break, the Senate voted unanimously to approve a bill that extended the SGR cut deadline to Dec. 31. The House of Representatives is expected to vote on the matter when it returns Nov. 29.

"They will probably either vote at the last minute to not cut payments, or they will wait until the cuts go into effect and reverse them," McDonald said.

"But even that is problematic, because Medicare is with-holding payments to doctors, while waiting on Congress to act, so that disrupts a doctor's cash flow."

Should Congress proceed with the payment cuts, there is an even larger issue at stake: patients' health, McDonald said.

"Physicians already believe in general that Medicare reimbursements are too low. If they are cut even further, a lot of physicians may further restrict the number of Medicare patients that they will accept," McDonald said.

"That would make it even harder for Medicare patients to get access to quality care. The bottom line is that the cuts hurt physicians, but more than that, it hurts patients."

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