Sarasota doctors again battle Medicare rate cuts
The annual game went into overtime before a last-minute save
David Gulliver - posted 1 p.m. Wednesday, March 3; updated information 2 p.m. Monday, March 8)
(Update: Sarasota and Manatee doctors and their patients are planning a rally to protest the scheduled Medicare cut, at 5:30 p.m. Wednesday, March 10, at Dolphin Aviation Center, 8191 N. Tamiami Trail, near the airport. )
Dr. Michael Patete might be breathing a bit easier today.
For months, the Venice physician was willing to bet any taker $1,000 that Congress would kill a scheduled 21 percent cut to Medicare's payments to doctors.
It seemed like a safe bet: Congress had canceled similar cuts for six years running. But this year the reduction went through -- for just two days, as it turned out -- when the Senate failed to pass a last-minute measure last Friday. Senators reversed course Tuesday night, approving a jobs bill that contained language extending the current Medicare payments through March 31.
Medicare's parent agency had already planned to hold up payments for 10 days, in anticipation of the fix. But the scare sent physicians scrambling across the Suncoast and nationwide, canceling or postponing appointments, calling banks about lines of credit or applying for loans -- and sending scathing letters to Congress.
Patete, a past president of the Sarasota County Medical Society who has lobbied in Washington, was not amused. "It's incredible what they're doing to us," he said. The medical society encouraged doctors to write Congress, and its director, Lynette Drain, said hundreds did just that.
Today, the society and the American Medical Association are pushing Congress for a permanent fix to the rate cuts. They stem from a law passed in 2002, which established a formula called the sustainable growth rate.
The SGR, as it is known, would have forced automatic cuts in what Medicare pays doctors. (It also is particularly onerous in most of Florida, where doctors outside Miami-Dade and Lee and Collier counties get less money via a geographic component of the formula.) Each year, though, doctors protest the cuts, and Congress postpones them for a year. But those postponements have now stacked up to the current 21.2 percent reduction. A stalling action by Sen. Jim Bunning, R-Kentucky, caused the cuts to go into effect Monday morning.
If that went through, it would lead to "my impending bankruptcy," Dr. Ann Pisicitelli, an internal medicine specialist in Venice, wrote in a letter to Sen. Bunning. "Due to our demographics here in Florida, my practice is comprised of 70 percent Medicare patients," she said.
That translates to cutting gross income by some 15 percent at many small practices, especially in southern Sarasota County, where more seniors live. And that would come as doctors face rising costs of property and liability insurance, try to convert to electronic records and pay their employees.
Patete and other doctors note that though Bunning triggered the brief crisis, he is not the only one at fault. Senate Majority Leader Harry Reid, D-Nevada, dropped a fix from a version of the jobs bill, reportedly fearing the bill would be criticized for helping special interest groups. And the SGR was expected to be replaced in the massive healthcare reform bill, now bogged down in Congress. "They had a year to fix this," Patete said.
The doctors may finally get their wish. Speaking to the AMA's annual National Advocacy Conference in Washington, D.C., this morning, Health and Human Services Secretary Kathleen Sebelius promised to scrap the SGR, Modern Healthcare reported in its online editions.
It still would require Congressional action, but lawmakers are on the record supporting such a change to the Medicare SGR. In her letter, Piscitelli quoted one of them:
"By cutting the reimbursement rates for providers, they are making it harder for seniors to find medical providers to treat them. Plain and simple. Seniors will have the same benefits, but if they cannot find anyone to treat them, then their benefits don't do them much good, do they? ... What do you think is going to happen when these reimbursement cuts go into effect?"
The speaker was Sen. Bunning, on Dec. 1, 2009.
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Editor's note: Dr. Piscitelli is a board member of Sarasota News Online, which publishes Sarasota Health News.
