Letters to the Editor

Effect of Medicare Cuts

Marc Siegel, MD, expresses sentiments all physicians should embrace with his call to continue treating Medicare patients despite reimbursement cuts. Still, the Medicare cuts put enormous financial pressure on a physician's practice. The ultimate result will be a reduction in the quality of care.

Health care should not be treated merely as a business, but any medical practice that tries to ignore economic realities will not stay open long. A physician's practice must receive more reimbursement than it pays in expenses, or else face bankruptcy. The payments that Medicare makes to physicians cover a broad range of practice expenses, including office staff salaries, medical equipment, and professional liability insurance. Costs for all of these expenses, especially liability insurance, are rapidly rising.

A recent analysis of the Medicare cuts by the American College of Physicians- American Society of Internal Medicine projected a minimum $122,000 reduction in annual revenue for a four-physician geriatric practice, the specialty that primarily treats Medicare patients. This would eliminate the salaries of the entire office staff in many medical practices.

The access problem will grow worse as rapid growth in the number of beneficiaries chases a smaller pool of doctors able to treat them. In 1990, 34 million Americans depended on Medicare. By 2010 that number will grow to 40 million and by 2030 to 68 million.

To deal with this enormous increase, Medicare must ensure a sufficient number of practicing physicians are available, especially in specialties such as internal medicine and geriatrics that concentrate on the care of the elderly. Future doctors will avoid specializing in the care of aging patients if they see well-established Medicare physicians constantly struggling to keep their practices open due to reimbursement cuts.

Congress should move quickly to fix the problem of cuts in Medicare payments before the program dies a slow death by financial starvation.

Sara Walker, MD, MACP
President
American College of Physicians - American Society of Internal Medicine

Return to the Letters to the Editor Menu