Letters to the Editor

Printed in The Forum
July 25, 2002

Drastic reductions in Medicare payments to health care providers threaten the health of North Dakota's over 100,000 plan beneficiaries. Doctors and medical practices that serve these patients must make cuts that will ultimately reduce the quality and availability of medical services due to Medicare's declining reimbursements.

Despite rapidly rising costs of running a medical practice, Medicare will rollback physician reimbursement rates to 1990 levels, a drop of nearly 20 percent between 2001 and 2005. The greater the number of Medicare patients a practice treats, the greater the cuts in reimbursement. As reimbursements fall, medical practices must decide how to reduce costs: eliminating staff, delaying medical equipment purchases, eliminating services or reducing the number of Medicare patients treated.

Compared to national statistics, North Dakota has a higher than average concentration of Medicare patients, but has only two-thirds the number of available physicians to treat them. Further reductions in the available physician pool loom as Medicare rates continue to decline.

The financial pressure created by the fee schedule reductions increases the likelihood of physicians retiring at earlier ages. The severity of the cuts for internal medicine and geriatrics means future doctors may decide not to pursue careers in fields that treat a majority of Medicare patients.

Congress must act to change the current Medicare fee schedule that ties reimbursement for health care services to the annual change in the Gross Domestic Product. This formula punishes physicians for economic downturns that are beyond their control. A new formula must be established, one that takes into consideration the increases in the aging population and in the costs of delivering care.

Medicare reimbursement typically pays staff salaries, rent and funds new equipment. Doctors may reduce office hours, limiting the number of appointments available in a day in efforts to save money. Advancements in medical technology may be passed up because physicians can no longer afford the training or the equipment.

On behalf of doctors of internal medicine, I urge the Senate and the White House to quickly enact legislation already passed by the House of Representatives that will guarantee physician payments keep pace with inflation through 2005. Meanwhile, Congress can return to the drawing board to make a permanent change in the method of calculating physician reimbursement. This approach guarantees Medicare patients will not suffer reduced access to care.

Rolf Paulson, MD, FACP
Governor, North Dakota Chapter
American College of Physicians- American Society of Internal Medicine

Return to the Letters to the Editor Menu