[Congressional Record Volume 152, Number 133 (Wednesday, December 6, 2006)]
[Senate]
[Pages S11245-S11247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PHYSICIAN PAYMENTS

  Ms. STABENOW. Mr. President, I rise to speak, as my colleague from 
New Mexico has spoken so eloquently, about a very serious issue we have 
to address before we leave for the year. Once again, I rise to speak 
about the urgency of providing our Nation's physicians with the 
resources they need to provide high-quality Medicare services to our 
seniors and people with disabilities. As my colleague indicated, this 
is something of the utmost importance that needs to be addressed now. 
There

[[Page S11246]]

is no reason we cannot address this before we leave.
  On September 21, I asked unanimous consent for the Senate to approve 
S. 1574, legislation that would provide for a 2-percent update to 
physicians as recommended by the Medicare Payment Advisory Commission, 
MedPAC. This particular bill was introduced by my colleague Senator 
Cantwell, and I thank her for her leadership on this important issue. 
My Republican colleagues objected to this request, and so nothing has 
happened in the last 75 days. We are running up to the end of the year, 
and yet nothing has happened. Nothing has happened to ensure that 
physicians will receive a modest update to their Medicare payments. 
Nothing has happened to ensure seniors and people with disabilities 
will have access to their doctors.
  Senator Cantwell and I each introduced legislation over a year ago to 
override the sustainable growth rate formula for Medicare physician 
payments--in other words, a formula that has been putting us on this 
road to a 5.1-percent cut come January. We knew then that the formula 
was wrong. It is not sustainable. It doesn't work. It needs to be 
fixed.
  We have known this day was coming. We know physician payments will be 
cut by over 5 percent on January 1--just a few weeks from now--if 
Congress doesn't act. We know Congress has only a few short days to 
complete the business for the year. We know what we need to do to solve 
the problem. While the clock is ticking down, we have time to address 
this issue. It is critical that we not leave here without addressing 
this for our seniors, for our families, for people with disabilities, 
and for the physicians of this country who are caring for those 
individuals.

  People say we are out of time. Some people buy Christmas presents on 
the afternoon of December 24, but there are people who run right up to 
the deadline. There are people who mail their tax returns right before 
midnight on April 15. We are in one of those situations. We have to 
decide to get this done because the deadline is here. We are running 
right up to the deadline. But we have to make this a priority before we 
leave. I know colleagues are working on both sides of the aisle as well 
as in the House to find a solution. It is critical that something be 
done, that it be fair, that it moves us in the right direction, not the 
wrong direction. It is not going to take long to get this done if 
people want to get it done.
  In less than 1 month, payments to physicians will be cut by 5 
percent. Under current law, while costs continue to increase, 
physicians will actually be paid less than they are paid today. As I 
mentioned in September, we know from the recent survey conducted by the 
AMA that if the scheduled cuts go into effect, 45 percent of doctors 
will decrease the number of Medicare patients they accept. Almost half 
of physicians will decrease the number of Medicare patients they can 
accept.
  Fifty percent of doctors will defer purchase of health information 
technology, which is another critical issue that I am pleased to be 
working on with colleagues on the other side of the aisle. We have a 
bipartisan consensus that we need to move forward on health information 
technology to save both money and lives. Yet we can't say to 
physicians: We are cutting the income coming in, we are cutting your 
payments for serving people, and by the way, we want you to spend money 
on new hardware and software and training people for a system that is 
critically important for the Federal Government to save money. That 
doesn't make any sense, and that is not going to happen.
  We also know that 37 percent of doctors practicing in rural 
communities--and Michigan has many rural communities--will be forced to 
discontinue rural outreach services. This is unfortunate for the people 
of Michigan as well as around the country. And 43 percent of physicians 
will decrease the number of TRICARE patients they serve.
  We are talking about people in the military and their families. This 
doesn't have to happen, if we can act and act quickly.
  Further, MedPAC considers the Medicare SGR formula to be flawed. It 
is an inequitable mechanism for controlling the volume of services. 
They recommended repeal of it in 2001 because it is not working. It is 
not working mostly for patients, and it is not working for physicians. 
Since that time in 2001, they have consistently recommended repealing 
the formula. MedPAC has stated that the cuts will be particularly 
devastating for primary care doctors--the very doctors many Medicare 
beneficiaries rely on for important health care management.
  This doesn't have to happen. We have the power to make sure it 
doesn't. While the problem is clear, fortunately so is the solution.
  MedPAC is an independent Federal body established by Congress in 1997 
to advise us on issues affecting the Medicare Program. In addition to 
advising Congress on payments to providers, MedPAC is also tasked with 
analyzing access to care and quality of care. In carrying out their 
charge, MedPAC has recommended a 2-percent physician payment update to 
keep them moving forward for next year. The change is one that I have 
advocated, and in fact 79 of my colleagues have joined me in seeking 
and directly tracking MedPAC's recommendations. In fact, 80 Senators 
have said that physicians must be provided with a positive Medicare 
payment update for 2007 before we adjourn.
  Eighty Members have signed a letter to the two leaders of the Senate. 
Senator Reid has indicated his full support in moving forward with 
this. Eighty Members have said yes, we know the problem, we know the 
solution. The will should be there. Eighty out of 100 Senators have 
said this needs to get done. I joined these 79 other Senators in 
sending a letter in July to our leaders. Senator Reid has positively 
responded. I thank him for that.
  We have less than 3 days to get this done. My colleagues working on 
this need to know we want to get this done, get this done in the right 
way, and that we will not leave until it is completed. We know if we do 
not provide some kind of modest update to Medicare physicians payments, 
our seniors and people with disabilities will lose access to their 
doctors. That is what this is all about. Shame on us if this happens.
  I am very proud of the work that over 20,000 MDs and DOs in Michigan 
each day provide 1.4 million seniors and people with disabilities in 
Michigan high quality medical services under the Medicare Program. I 
want them to be able to continue to do that. There is no way they can 
if, while their costs are going up, their time with patients goes up 
because of the complexities of dealing with many older citizens and 
people with disabilities, yet at the same time their reimbursements for 
those services are going down.
  Beginning January 1, the average cut for a physician in Michigan 
would be $34,000 per year. How can we ask them to increase their level 
of care to support and expand what they are doing as more and more 
people enter the Medicare Program while we are making those cuts every 
year? It is not sustainable. It does not make any sense that at a time 
when medical costs are going up, the payments and reimbursements are 
going down.
  I have had many opportunities to hear from physicians in Michigan. 
Let me mention a couple of them. I will read a letter I received from 
Dr. Gela Pala, geriatrician and resident of Oakland County, MI. She 
puts the problems in words that make the situation we face very clear.

       As a resident of Oakland County, Michigan and practicing 
     geriatrician I believe cutting further Medicare physician 
     reimbursement will be a mistake.
       Most of my patients are above 70 years old and they come to 
     the office with a list of 10 to 20 medications and 10 or more 
     diagnoses. I routinely spend 1 hour or more with a patient 
     and family to discuss options of care, realistic goals/
     expectations and coordinate care.
       As medicine is becoming more and more complex I anticipate 
     we, patients and doctors, will need to increase the time we 
     spend together.
       I doubt an 80 year old cognitively impaired grandmother 
     will need less medical attention in the future. I doubt that 
     she will be able to navigate the complexities of the medical 
     system alone or with help from brochures, computers, etc.
       I can see my patient getting lost in the shuffle of ``cost 
     effective'' medicine.
       I can see the doctors ordering more tests because nobody 
     had the time to discuss the prognosis. I can see my patient 
     going from one office to another trying to understand what is 
     wrong, how to fix things and how to differentiate between 
     what is fixable and what is not.

[[Page S11247]]

       Cutting physician reimbursement will not make our nation 
     stronger, healthier or safer.
       I believe that less physician time will mean less health 
     and more healthcare cost.
       Please take action to prevent further deterioration of the 
     medical care for the elderly.

  I couldn't agree more.
  I have heard from so many people regarding this issue. I will read 
one more statement, from Dr. Thomas Watkins, a DO and family practice 
physician in Muskegon, MI:

       It will be a travesty for many seniors if doctors stop 
     accepting Medicare due to fund cutting. With our expenses 
     going up 5-10 percent annually and Medicare cutting 5 percent 
     next year it will be very difficult for many of my colleagues 
     and myself to continue to practice medicine for Medicare 
     recipients. Please at least vote to freeze the fee schedule 
     to allow access for all seniors to the physician of their 
     choice, just as you have that privilege.

  I simply ask that we act now. We have no more time to wait. People 
are counting on us.
  The PRESIDING OFFICER (Mr. Vitter). The Senator from Tennessee is 
recognized.
  Mr. ALEXANDER. I ask unanimous consent to speak as in morning 
business for up to 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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