Doctors opting out of Medicare after reimbursement cutback

Posted: Wednesday, December 18, 2002

ANCHORAGE (AP) -- Health care providers affiliated with Medicare will take an estimated 4.4 percent reimbursement cut under a rule expected to go into effect in February.

The cut is the second of four projected decreases in compensation, and physicians are opting out of the program, said Dr. Bruce Kiessling, a partner with Primary Care Associates in Anchorage.

''It's not a trend, it's a tsunami,'' Kiessling told the Alaska Journal of Commerce. ''No one is taking new Medicare patients with the exception of the residency program and community health care.''

Kiessling estimated that 40 percent of Alaska physicians will opt out of the program. The hardest hit, he said, are primary care physicians.

''We're the Rodney Dangerfield of the medical profession,'' he said. ''It can take anywhere between four and six months to process a single claim, and, in the meantime, we're paying overhead costs out of our pockets.''

Alaska is home to roughly 47,000 Medicare recipients and 3,620 participating doctors. A 5.4 percent cut last year amounted to a loss of about $1.8 million for those physicians, according to the American Medical Association.

If the anticipated cuts continue, Alaska doctors would lose an additional $10 million by 2005.

Pamela Negri, a public affairs specialist at the Seattle office of the Centers for Medicare & Medicaid Services, said the reduction would not mean that Medicare was paying out fewer dollars overall, but that those dollars had been ranked differently.

Medicare payments are based on the declared worth of the 7,000 different types of service Medicare covers, according to Thomas A. Scully, administrator of the Centers for Medicare & Medicaid Services.

Scully told a congressional committee that the physician's payment is adjusted by looking at the number and type of beneficiaries receiving Medicare coverage; changes in the costs of physicians' services; changes in expenditures due to new laws; and projected changes in the gross domestic product.

Negri said economic fluctuation adds a degree of difficulty to the calculation.

''It is CMS's position that the fee schedule needs to be changed, but at this point CMS can do nothing but move forward,'' she said.

The physician's payment schedule was originally slated to come out Nov. 1, but was delayed because the CMS was concerned about some of the data.

''The rule is scheduled for a Feb. 1 implementation date,'' said Peter Ashkenaz, a spokesman for the centers. ''For the month of January, doctors will be receiving the 2002 payment.''

Ashkenaz said the new regulation must clear channels of approval before it is published in the Federal Register. Congress will have 60 days to review and change the proposal after it is published.

Kiessling said Medicare recipients need to become politically active if the system is to change.

''I used to coach soccer and I would tell my kids at half-time, 'You can either play to win or play to not lose.' (The seniors) are playing to not lose,'' he said. ''But, if they want change, the gray pussy cats are going to have to become the gray panthers.''

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