Medicare reform-our careers are at stake

October 1, 2007

This year, the issue of how much Medicare pays doctors for seeing patients is front and center in Washington. For almost the last decade, physicians have been faced with huge cuts in their reimbursement from Medicare. A group of like-minded Democrats and Republicans have come up with a viable plan to change the way the SGR is calculated, and to stave off cuts for the next 2 years. Money is tight in Washington right now, but if physicians' voice is loud enough-including residents and fellows-there is a chance that this year really could be different.

Keypoints:

Fall is when things happen in Washington. Our elected officials return from summer recess and get down to business. This year, the issue of how much Medicare pays us for seeing patients is front and center. For nearly the past decade, physicians have been faced with huge cuts in their reimbursements from Medicare. In 2002, we actually were hit with a 5.4% decrease in payments because of a provision called the Sustainable Growth Rate (SGR), which plays a key role in how reimbursement rates are calculated. Given the rates of inflation-including malpractice insurance, medical equipment, and rent- many physicians mockingly have dubbed it the "Unsustainable" Growth Rate.

You don't need to be a business guru to realize that decreasing income and increasing expenses are a formula for disaster. Unsustainable, indeed.

For years now, we all have fought valiantly-a grand coalition of physicians in all fields, the American Medical Association (AMA), and the specialty societies-to stave off the rounds of cuts. It has been an awe-inspiring sight to see how well everyone has worked in a concerted fashion year after year. Physicians have called, emailed, and met with their elected leaders; the American Academy of Ophthalmology (AAO), the AMA, and others have sent in their lobbyists; senior citizen groups have voiced their concerns about doctors turning away Medicare patients. This effort has repeated itself year after year.With our coalition intensifying its efforts every fall, we have successfully beaten back yearly cuts of 4% to 5% and replaced them with 0% to 1.5% increases. Because those updates are actually less than the rate of medical inflation, they still technically are decreases, but they are an improvement nonetheless.

As a medical student and a resident, I have had the chance to participate in several lobby days in Washington to talk with my state senators and representatives about this issue and its impact on career choice and patients. I always have been impressed with how interested our leaders are in hearing from the youngest members of the group. As a fellow this year, all of those issues are getting very personal for me.We are the future of the medical profession. It is vital for all of us to speak up and be heard. Our entire careers, and our patients' ophthalmic health, depend on Medicare. If you are going to the AAO meeting this year, be sure to attend the Young Ophthalmologists' program, where issues such as this will be discussed.

A proposal that could work

After all the years of frustration, we are now at a crossroads. This year truly is different. A group of like-minded Democrats and Republicans have come up with a viable plan to change the way the SGR is calculated and to stave off cuts for the next 2 years. Specifically, the bill gives a 0.5% increase in reimbursement for 2008 and 2009, avoiding the 10% cut that is forecast for 2008. In addition, the proposal uses different variables to calculate the SGR, with-one hopes-a more favorable outcome for physicians.

As of this writing, the House seems closer to being on board with the proposal, compared with the Senate. Initially, the House had attached the SGR proposal to renewal of the Children's Health Insurance Program (CHIP), a health insurance program targeted to low-income children, but the issues later were separated.

The proposal seems to be gaining momentum in Congress, but money is tight in Washington right now, especially with expenses related to the war in Iraq. It is all up in the air right now, but if our collective voice-including residents and fellows-is loud enough, there is a chance that this year really could be different.

For more information, go to http://www.aao.org/advocacy/.