Apr. 7, 2008 Medicare patients -- many of whom have multiple chronic illnesses -- face severe difficulty in receiving healthcare if Congress does not act to avert pending cuts to Medicare payments, according to first-hand reports from physicians who specialize in internal medicine released by the 125,000-member American College of Physicians (ACP). Concerns about the impact of the cuts on access-to-care were evident from the responses of almost 2000 internists who, in response to a request from ACP, completed a questionnaire on the impact of the cuts.
Medicare payments to physicians are scheduled to be cut by 10.6 percent on June 30, and by another 5 percent on January 1, 2009. "Most patients -- and as America ages, those numbers will include more and more Medicare recipients -- receive their care from small-practice settings with 10 or fewer physicians.
These physician practices are run like any other small business," said Jeffrey P. Harris, MD, FACP, president-elect of ACP. "Our members, internal medicine physicians, are concerned that the scheduled cuts will have such an adverse impact that many of them will be forced to close their practices or limit how many Medicare patients can be accepted."
The cuts are the result of the flawed formula used to calculate Medicare payments to physicians. ACP, the largest medical specialty association, is asking Congress to pass legislation that will stop the impending cuts to payments. The organization is also calling on Congress for a long-term solution to replace the current formula with a reimbursement formula that would provide for permanent, predictable, and positive updates to physician payments.
The reports from ACP members sought specifics from practicing internists about how further payment cuts would affect their practices and their patients. Although not designed as a statistically valid survey, each of the reports from internists in practice provides a "real-life" glimpse into how patients may be affected by the Medicare cuts. Internists, on average, treat 2,000 patients, with an average of 800 Medicare patients. Their candid answers give real stories of what the cuts will mean to patients.
Almost a third of the internal medicine physicians said they would discontinue seeing new Medicare patients if the 10.6 percent cut goes into effect.
"In my geographic area, as much as 50 percent or more of an internal medicine practice consists of Medicare-aged patients" said a practicing physician in Florida. "Our office gets dozens of calls each week for new Medicare patients wanting to establish care with our physicians.
"If we are to endure further cuts in an already under-reimbursed sector of our patient base," the doctor continued, "we will likely stop accepting new Medicare patients. It's something most internists in the area will be forced to do. And it will cause an even greater access-to-care crisis than is already the case in our area."
While nearly nine out of 10 responding internal medicine physicians said they will make changes to their practices, 30 percent said they already have taken some steps to make changes in their practices in anticipation of the scheduled Medicare cuts. The changes they have taken include not accepting any new Medicare patients; postponing capital purchases for their practice; and reconsidering plans to purchase health information technology.
Also reflecting a frustration about patient-access was the finding that 48 percent of the physicians who already have made changes to their practices said one of their changes is accelerating their plans to retire from practice. And, 62 percent of the physicians who indicated they will make changes if the July cut takes effect said that they will further accelerate their plans to retire from practicing medicine.
Seventy-two percent of respondents said Medicare patients already need to put in a high level of effort to find a primary care physician in their communities.
Another part of the survey asked medical students and physicians in academic settings about the effects that cuts to Medicare payments could have on the careers of future physicians. "ACP wanted to know what the not-too-distant future for care of the increasing number of Medicare patients may be," noted Dr. Harris.
The most dramatic response was that 100 percent of the responding medical students said that Medicare physician payments are at least somewhat important in a medical student's selection of a specialty.
More than 60 percent of the medical students said that if they chose to specialize in internal medicine they will choose to sub-specialize rather than go into general internal medicine.
By contrast, some 89 percent of the teaching physicians said they believe that positive and predictable Medicare payments would increase the number of students choosing to train in primary care medicine.
One internal medical educator pointed out that, "teaching in a residency program, I come across medical students who are less likely to choose internal medicine as their career due to already low pay and high education loans. The scheduled cuts will certainly drive them away from internal medicine, making future healthcare difficult for all ages."
In May, ACP will host a series of events held over five days in Washington to highlight the impact of the dysfunctional payment system on practicing physicians and patients, the state of today's health care environment and the need to reform the national health care system.
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