AMA warns of threat to doctors' pay

Congress is accused of delaying action on reimbursement cuts.

By JOSIE HUANG Staff Writer
http://pressherald.mainetoday.com

Congress’ habit of waiting until the last minute before stopping Medicare from cutting payments to doctors has become so familiar that the president-elect of the American Medical Association jokes it is the “annual dance of death.”

With another round of reimbursement reductions planned for January, Dr. Nancy Nielsen said during a visit to Maine on Tuesday that doctors are more worried than ever — and the elderly and disabled patients they see should be, too.

Pay cuts planned by Medicare to offset overspending in the federal program are double what has been proposed in the past five years – and Congress, to date, has not addressed the issue in any legislation.

The health insurance industry charges that physicians are partly to blame, and contribute to costs by ordering unnecessary and expensive services. But the AMA says doctors are just trying to keep up with a Medicare population that is bursting with baby boomers.

“This is not a manufactured crisis, this is very real,” Nielsen said at a press conference at the Intermed physician practice.

Doctors in Cumberland and York counties face an 11.1 percent cut. The proposal is 12.2 percent for the rest of Maine, where wages and the cost of living are lower. Combined, the cuts would cost Maine doctors $27 million, said the AMA.

Doctors would have to limit new Medicare patients and defer improvements such as computerizing records, Nielsen said. Recruiting employees, she said, could become harder.

The AMA has suggested that Congress find savings by paying Medicare Advantage plans offered by private insurers at the same rate as traditional fee-for-service Medicare plans.

The private plans are now reimbursed at a 12 percent higher rate, Nielsen said.

But an industry group for insurers rejects the idea. America’s Health Insurance Plans spokesman Mohit Ghose said Medicare Advantage plans offer coordinated care to 8 million people, and the AMA’s proposal would be “taking money away from fixed- income seniors.”

Ghose questioned whether physicians are always providing “appropriate services at the right setting at the right time.”

Maine is the fourth stop for the AMA as it tries to raise awareness about the looming cuts in states that it says has large ratios of Medicare patients.

With 220,000 people in Medicare, Maine has one of the country’s highest rate of beneficiaries. It also has a below-average ratio of physicians to Medicare patients, according to Dr. Kevin Flanigan, president of the Maine Medical Association.

He said that in his two-person practice in Pittsfield, Medicare recipients account for 45 percent of the patients. “Until now, I have been able to control costs, but not to the extent that I can handle a 10 percent decrease in Medicare,” Flanigan said.

The AMA said doctors are being reimbursed at the same rate as in 2001. To cover the higher cost of doing business, the group advocates a 1.7 percent rise in reimbursement next year.

For a long-term solution, the AMA wants Congress to create a new reimbursement formula – which all four members of Maine’s congressional delegation indicated they support.

Rep. Tom Allen, D-Maine, said he expects a “two-year fix” for doctors to be part of a bill addressing the expansion of insurance for low-income children.

Where the money would come from is not clear. But in a statement, Republican Sen. Olympia Snowe said she wants “to assure that excessive payments to Medicare managed care plans are addressed so that all physicians may be paid equitably.”
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