Doctors’ Medicare refunds to drop 20 percent Monday

Published 12:00 am Saturday, February 27, 2010

With Medicare reimbursement rates to physicians set to drop by more than 20 percent Monday, Vicksburg physician Randy Easterling, president of the Mississippi State Medical Association, is warning that elderly patients could find themselves with no doctor able to afford to treat them.

Easterling said the 21.2 percent decrease in Medicare reimbursements to doctors will automatically go into effect Monday unless Congress votes to stop it.

“They didn’t vote to stop it last night (Thursday night),” Easterling said Friday. “Maybe they’ll do it this weekend, but if they don’t, doctors won’t be able to see these patients.”

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The U.S. House passed H.R. 4691, a “Temporary Extension Act,” Thursday, postponing the reimbursement cuts until the end of the month, but the measure, tied to other legislation, did not pass in the Senate. The Senate adjourned just before noon Friday and wasn’t expected to reconvene until Monday afternoon, according to a floor schedule on the Senate’s Web page. The site indicated no votes had been cast.

A domino-effect could also impact the state’s low-income patients on Medicaid, because Mississippi Medicaid reimbursement is a percentage of Medicare, Easterling said. If one goes down, so does the other.

Some local doctors have already stopped accepting new Medicaid patients. One Vicksburg woman trying to get an appointment for her granddaughter, covered by Medicaid, was told just one pediatrician would see her.

“I can’t understand how doctors can say they’re not seeing Medicaid patients, especially the babies,” said Pertrennia Carson, who’s paid into the Medicare/Medicaid system through payroll deductions for years, and would add her granddaughter to her own health insurance policy if allowed. “It’s not her fault. She has no control over how the doctor gets paid.”

The pay cut is determined by the “SGR” — sustainable growth rate — put into effect by Congress in 1997 to figure Medicare reimbursements. While the cost of running a practice has gone up about 6 percent annually, Medicare reimbursements pegged to the SGR have increased less than 1 percent a year in the last eight years, Easterling said.

Easterling said a permanent fix is needed. “It’s a huge problem,” he said, with the elderly facing difficulty seeing specialists such as cardiologists and oncologists, as well as primary care physicians.

Easterling and other MSMA board members have asked Mississippi’s senators, Thad Cochran and Roger Wicker, both Republicans, to support revamping SGR, which they call “fatally flawed,” before it requires doctors to “limit access to care for our state’s 477,000 Medicare beneficiaries and 115,000 (Tricare or veterans’ insurance) patients, just to keep their offices open,” they wrote in a January letter to Wicker published on their Web site.

Cochran supports it can be funded, spokesman Chris Gallegos said in an e-mail,

“He understands the frustration felt by many doctors as Congress tries to address this issue, and that the short-term fixes are not ideal,” Gallegos said. “But until Congress finds a more permanent solution to address and pay for this $50 billion problem, these short-term measures are the alternative to ensure that those who use Medicare and TRICARE are not adversely affected.”

A spokesman for Wicker said the senator also supports an overhaul.

“Sen. Wicker supports a permanent fix to the doctors’ reimbursement problem and has introduced legislation to do just that,” said Courtney Sanders in an e-mail. “He has voted to stop the cuts over half a dozen times in the past. The few times he was forced to vote against long-term fix legislation, it was tied to Medicare cuts or deficit increases of over $200 billion. The senator has been, and continues to be, fully supportive of finding a lasting, responsible solution to this problem.”

Senior advocate organization AARP also supports scrapping SGR for a different schedule.

“AARP wants to protect and strengthen Medicare,” said Ronda Gooden, associate state director of communications for Mississippi AARP, which has 286,000 members. “We don’t want to see doctors’ reimbursements cut, but want our members and all elderly people to get the medical care they need.”

Seven times in the last seven years, Congress has had to override SGR funding. Monday’s cut was originally to take effect Jan. 1, but was put off for two months by legislation signed into law by President Barack Obama Dec. 21.

Contact Pamela Hitchins at