July 3, 2008, 11:59PM
More Texas doctors opting out of Medicare
Nearly half of physicians in Texas say they can no longer afford to take new patients
By TODD ACKERMAN
Copyright 2008 Houston Chronicle
In an ominous trend for baby boomers, Texas doctors are opting out of Medicare, weary of the perennial fights over cuts in reimbursement.
Only 58 percent of doctors in the state now accept new Medicare patients, according to a recent survey by the Texas Medical Association, down from an estimated 90 percent before 1990. Among primary-care doctors, the percentage is 38 percent.
TMA leaders predict the percentage will continue to plummet if Congress doesn't arrive at a long-term solution soon. Congress returns from a Fourth of July recess Monday needing a short-term fix just to avert a 10.6 percent reimbursement cut scheduled to go into effect July 15.
"In my 50 years in medicine, I've not seen the level of frustration and anger out there now," said TMA President Dr. Josie Williams. "Most doctors have got to the point that they don't think the real problem's ever going to be fixed and are looking at whether to continue participating. They feel they've carried Medicare on their back as long as they can."
Dr. Tom Garcia, president of the Harris County Medical Society, called Medicare "the new Medicaid," a reference to the even lower percentage of doctors who opt into the government insurance program for low-income people.
The struggle to find a doctor who still takes new Medicare beneficiaries has hit home for Robert Sloane, a Fort Worth senior whose longtime doctor took early retirement and left him looking for a replacement.
Sloane got the same response from receptionists of each doctor he called: They would ask his age, birthday or insurance carrier, then say they would have to get back to him. Only they never would, he said.
"They were always very nice, but the questions were a clear code that they didn't take Medicare patients," said Sloane, a retired surgeon. "The whole experience gave me a first-hand feel for a problem I'd only heard stories about before."
Sloane finally found a doctor after one who usually didn't take Medicare patients accepted him as a professional courtesy.
Medicare's 10.6 percent cut was to have taken effect Tuesday. But the Centers for Medicare and Medicaid Services, or CMS, announced Monday it would process no new claims until July 15, giving Congress a reprieve to block the reduction.
'Medicare exodus' possible
Were the 10.6 percent cut and an additional 5 percent cut scheduled for January 2009 to go through, Texas doctors would lose $860 million treating the elderly and disabled over the next 18 months, according to TMA. On average, each Texas doctor would face an $18,000 cut over that period.
If that happened, said one Texas doctor, "you can't imagine the Medicare exodus" that would follow.
Congress, mired in partisan bickering about how to pay for the additional funding both parties agree is necessary, already missed a June 30 deadline to prevent the 10.6 percent cut.
CMS intervened after the Senate voted last week not to take up legislation passed by the House. That would have dipped into a Medicare pool of money that currently goes to private, fee-for-service insurers and use it for the traditional Medicare program. President Bush had vowed to veto that bill.
Still, Congress is expected to reach a quick compromise next week — partly because neither party wants to alienate millions of seniors voting in November.
Texas Sens. John Cornyn and Kay Bailey Hutchison say they're hopeful about the prospects of a bipartisan resolution, and many Washington observers see the CMS move as a strong signal Congress must act.
But the resolution is widely seen as another Band-Aid, not the fundamental reform that doctors say is needed so battles don't keep coming up annually.
Physicians say the problem is a statutory formula that leaves less money to go around as more people use the program. Left intact, they say, the formula would reduce reimbursements by 40 percent over the next nine years.
Among those who agree with doctors is Cornyn.
Instead of reforming the system, Cornyn said Tuesday in a letter to his Senate colleagues, Congress has made "a never-ending series of patchwork fixes that were inefficient and costly and caused undue hardship on everyone involved."
Cornyn has sponsored a bill, endorsed by the TMA, that would get rid of the formula. But real consideration of the legislation is not expected to come until a new Congress takes over in January.
In the meantime, doctors are fretting. Hardest hit in Texas, say TMA leaders, are doctors in the inner city, in rural areas and along the border in the Rio Grande Valley — doctors whose patient load is often 80 percent or more Medicare beneficiaries.
Hard choices for doctors
With reimbursements cut 20 percent in inflation-adjusted dollars the last seven years, many such doctors are having a hard time making a go of it.
Houston internist Lisa Ehrlich found that the only way she could keep her current patients as they became eligible for Medicare was not to take on new Medicare patients.
"Every year, it comes up that there's going to be a cut, then they say, no cut," she said. "But there's no inflationary increase, and we make less and less."
The obvious losers, said former TMA President Dr. Bohn Allen, will be the baby boomers who have reached their retirement years.
"I don't know why Congress would want to make it so Medicare beneficiaries can't get access to care," Allen said. "They may not realize it, but we've reached a tipping point."
Chronicle reporter Purva Patel contributed to this story.