Half of Texas physicians would consider withdrawing from the Medicare program if Congress allows a forthcoming deep cut in reimbursement payments, Texas Medical Association officials said Thursday.
The result of the cut could mean more elderly people would lose access to their doctors and have trouble finding new ones, said Dr. Bruce Malone, association president.
Malone shared the results of the association survey of physicians while calling for federal lawmakers to revamp the payment formula for doctors. Without action, physicians will see a 29.6 percent cut in reimbursements starting Jan. 1.
In Tarrant County, 48 percent of physicians said they would consider opting out of the program after such a reduction.
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"That would be a major crisis for doctors," Malone said. "We love our Medicare patients, and the last thing we want to do is have to stop taking care of them because we physically can't do it and survive."
More than 1,900 Texas doctors responded to the August survey, according to the association.
Problems with formula
The formula is intended to control Medicare costs by reducing reimbursements to doctors if the program's previous year's spending exceeds targeted levels, which first happened in 2001. Spending has continued to surpass targets each year, but Congress has "kicked the can" down the road, making band-aid fixes to delay cuts instead of fixing the defective formula, physicians say.
Meanwhile, that Medicare debt had grown to $350 billion, and the size of the proposed cut has grown with it, according to the medical association.
"It's not a party-based issue; it is a Republican and a Democratic issue," Malone said. "This has been going on for a decade, and they have kept delaying fixing it. Now we are in a situation where we have other debt crisis problems, so we are concerned this is going to get lost in the shuffle."
Medicare payments to hospitals, skilled nursing homes and home health agencies have increased in the last 10 years, but physician payments have stayed generally flat, Malone said.
Some providers have already stopped accepting new patients whose primary insurance is Medicare. Dr. Gregory Sheff, medical director of clinical integration for Austin Regional Clinic, said current patients can stay with the clinic as they become eligible for Medicare. But new Medicare patients are usually not accepted. Still, the clinic expects its Medicare population to double within five years as current patients age, he said.
Most people become eligible for Medicare when they turn 65.
"Essentially what it costs us to run our practice is 120 percent of what Medicare reimburses," he said. "It's already essentially subsidized. If you take that and then drop 30 percent off it, there comes a point where it is just not viable."
Tricare also affected
For physicians still accepting new Medicare patients, Tarrant County has one of the highest rates in the state at 74 percent, said Dr. Susan Bailey, a Fort Worth allergist and past president of the association.
But 12 percent of Tarrant County physicians said they would definitely opt of out of the program if the cut occurs, she said. That figure, on top of the 48 percent who said they would consider it, means the program could lose a lot of doctors.
Elderly and disabled patients are not the only ones who could suffer, she said. The military's Tricare health system would similarly be affected by a drop in reimbursement rates because Tricare's reimbursement rates are tied to Medicare's.
Tricare is the healthcare system for active-duty troops, reservists and National Guard members who are mobilized and retirees under the age of 65. Because of the historically low reimbursement rates, which are often below even Medicare's, families say it is difficult to find physicians who accept the insurance.
"We are calling on Congress to fix this program once and for all," she said.
Staff writer Chris Vaughn contributed to this report.
Alex Branch, 817-390-7689