Letters to the Editor

Access to Care Threatened, Medicare Reform Needed

Medicare beneficiaries in rural areas of Illinois face tough times as the number of health care providers shrinks. Between 2001 and 2005, Medicare will cut reimbursements to physicians by nearly 20 percent, allowing reimbursements to drop below the costs of providing care. In 2002 alone, Illinois physicians lost nearly $1 billion dollars.

When Medicare no longer covers the costs of care, doctors have limited options to trim practice costs: reduce services, reduce the number of Medicare patients they care for, or cut staff and equipment simply to keep their practices open. With 1.6 million Medicare patients, Illinois can ill afford to lose these services.

As specialists in the care of adults, doctors of internal medicine treat a disproportionate number of Medicare patients. Many patients suffer from chronic and multiple illnesses that require regular monitoring and treatment. This leaves the physicians most frequented by Medicare patients the most vulnerable to financial disaster.

Historically, Medicare reimbursements covered, at minimum, the costs of rent, utilities, and administrative staff. A compensation formula enacted by Congress in 1997 reversed this tradition and linked physician reimbursement to the performance of the economy. During economic downturns, this link threatens the financial viability of medical practices that see large numbers of Medicare patients, penalizing doctors for things far beyond their control.

Compounding the effect of these cuts, Medicare made several erroneous assumptions in calculating payments in 1997. These errors permanently removed billions of dollars from the physician compensation pool. Medicare claims it cannot correct these errors.

Guaranteeing that payments keep pace with inflation is vital to ensuring adequate numbers of physicians for Medicare beneficiaries. I strongly urge Congress and the White House to provide immediate relief from these destructive cuts. Congress must then find a permanent solution that provides adequate payments for medical services provided to Medicare patients.

Stephen Goetter, MD, FACP
Governor, Illinois Chapter
American College of Physicians-American Society of Internal Medicine

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