Dr. Jay Taylor, president of the Lake County Medical Society, and Dr. Frank Jevnikar, secretary-treasurer of the LCMS, rounded up 25 physicians in the county to ask them what they would do if a proposed a 9.9 percent cut to Medicare physicians occurs Jan. 1, as planned.
"For the past five years, Congress has intervened to prevent the implementation of the negative updates resulting from (the sustainable growth rate formula for physician fees)," said Leslie Norwalk, acting administrator for CMS, an extension of the U.S. Department of Health and Human Services.
"CMS will continue working with Congress, as well as physician groups to identify payment methods that help improve the quality and efficiency of care in a way that is cognizant of the costs to taxpayers and to Medicare and its beneficiaries."
But to let the Lake County doctors tell it, the work that needs to be done is simple - Congress should not reduce reimbursements to Medicare service providers.
According to the Jevnikar and Taylor study, 17 of the 25 respondents said they would eliminate services to Medicare patients altogether if the cuts go through. The 25 physicians care for about 55,000 patients in Lake County, Jevnikar said.
"It'll be a real Medicare accessibility problem if the cut goes through," said Taylor, a family practitioner at the Lake County Family Practice in Mentor. "I think this is an issue that's going to sneak up on the community."
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Jevnikar and Taylor got their idea from a more revealing American Medical Association survey conducted in May. In that study, 8,955 physicians were asked how the cuts would affect them. Sixty percent of the respondents said they plan to limit the number of new Medicare patients they treat.
Jevnikar hopes his own study will mean the public won't forget about the issue with more than three months left before the proposed cut would take place.
On Thursday, after President Bush challenged Democrats regarding increases to the State Children's Health Insurance Program, House Speaker Nancy Pelosi, D-Calif., said the House would return later in the year to address the physician cuts.
SCHIP, which provides health care coverage to more than 6 million people, mostly children, is scheduled to expire Sept. 30.
"The AMA is deeply disappointed that congressional leaders have decided to defer action to stop Medicare cuts to physicians," AMA President-elect Dr. Nancy Nielsen said in a news release. "Time is of the essence as the clock winds down on SCHIP, and the clock is also ticking for action to stop Medicare cuts to physicians that begin Jan. 1."
Jevnikar said physicians have been down this road before, with the last cut going through in 2002. In the years since that 4.8 percent reduction to doctor reimbursement, cuts have been proposed and then curtailed with no cuts or slight increases, according to the AMA.
Various concerns exist between the national and local studies. AMA Board of Trustees Chairman Dr. Cecil B. Wilson pointed to less care being available for baby boomers who will enter the Medicare program in 2010.
Conversely, Taylor said some doctors could begin to see an excess amount of Medicare patients, making up for lost reimbursement funds.
Other study results include:
* 16 of 25 Lake County physicians would be forced to lay off staff members
* Seven of the 25 respondents said they would close their offices if the cut goes through
* Three of 25 would consider salary cuts for their staff.
Good representation?
"Physicians don't make good poster children," Taylor said while discussing the various ways his study and the push to eliminate cuts could be viewed.
"We're very worried that this is going to be perceived or spun in a way that says a bunch of millionaires are just complaining," said Jevnikar, a urologist with offices in Mentor and Willoughby. "We know we're perceived as financially well off, but this is beyond physicians living within their means - this is about access to health care."
Jevnikar said physician's practices are no different from other businesses, in that they have to pay for electricity, gas, water and staff salaries. Those costs could be difficult for smaller operations to manage if the reimbursements are cut.
"It's really about practice expenditure and sustaining your bottom line as far as maintaining your business, or being able to stay in business to provide care," Taylor said. "All of the other insurance companies tie into the Medicare benchmark, so if there's a cut in Medicare, all of a sudden, other companies feel so motivated to cut their reimbursement to physicians to create a whole downward spiral."
Pelosi's promise that the House would address the cut could include a cut in payments for some insurance plans serving beneficiaries in the Medicare Advantage program, where private insurers provide benefits to seniors instead of the government. That would, in turn, help pay for an increase in the traditional Medicare reimbursements.
Before pushing for a $35 billion spending increase for SCHIP, the House previously called for a $50 billion expansion that would have been paid for by raising tobacco taxes and lowering subsidies to private insurers that offer Medicare benefits. The $35 billion increase is said to be a compromise, with most, or all, covered by the tobacco tax.
Jevnikar said U.S. Rep. Steven C. LaTourette, R-Bainbridge Township, solicited some opinions on an earlier version of a House bill to combine reform of SCHIP and the Medicare reimbursements. But that bill did not pass an August vote.
"I've tried to make contact with (U.S. Rep. Stephanie Tubbs Jones, D-Cleveland), but I received one of those, 'Thank you very much, health care is very important to us,' form of letters," Jevnikar said. "It's not on the radar screen."
Tubbs Jones said she was deeply concerned about the issue and wishes some of the money spent on the war in Iraq would have been used to ease the situation.
"If you ask any physician in my congressional district, I'm a champion for physicians," she said. "I pray that if there are cuts, they would not cause physicians to forego Medicare patients.
"It's not only the doctors, everyone's trying."
For now, doctors, politicians and patients will wait to see if any changes are made before Jan. 1.
"The political radar screen is full of Iraq and the new presidential issues coming up," Jevnikar said.
"When our senior citizens, who deserve to be heard, start sounding off, it's going to make its way back to the radar screen, where it belongs."
The Associated Press contributed to this report.
