Medicare is on Life Support
by Len Cannon / 11 News
Posted on December 16, 2009 at 9:00 PM
Updated Wednesday, Dec 16 at 11:02 PM
HOUSTON—Dr. Mina Sinacori, an OBGYN at the new Memorial Hermann Hospital in West Houston, and Dr. Steven Brown, chief of staff at LBJ Hospital, have the same diagnosis for Medicare.
They say the plan which provides health care for those age 65 and older is on life support because of how it pays doctors.
"You know, the formula they use to calculate doctor reimbursement is flawed. It doesn’t take into consideration the increasing cost of running a medical practice," Sinacori said.
The formula she’s talking about is the Sustainable Growth Rate, better known as SGR. It’s used to determine the fee schedule for doctors who treat Medicare patients.
Many doctors feel the rate is too low.
To make matters worse, the SGR calls for doctors to take a 21-percent rate cut on January 1, 2010.
The American Medical Association is urging Congress to fix the payment formula. They say without a change, the elderly will have less access to care, because some doctors may decide it’s just not worth seeing Medicare patients.
"Practices are still seeing Medicare patients—that’s true. But probably an increasing fraction have decided not to take new Medicare patients," Brown said.
In fact, a 2008 survey of doctors by the Texas Medical Association revealed a frightening trend.
Doctors were asked what actions they were taking as a result of "ongoing problems with Medicare."
Nearly 60 percent said they will no longer accept Medicare patients, or are considering doing so.
Sinacori is in that group – she’s decided not to see any new Medicare patients.
"My parents are on Medicare, so many patients we love are on Medicare, but at the end of the day, I have expenses as a physician running a small business that I need to meet," Sinacori said.
In two years, the first wave of baby boomers will become eligible for Medicare.
If Congress doesn’t address the issue, doctors say those boomers will have less access and fewer choices.