[Congressional Record (Bound Edition), Volume 149 (2003), Part 18]
[House]
[Page 24686]
[From the U.S. Government Publishing Office, www.gpo.gov]




            DECLINING MEDICARE REIMBURSEMENTS FOR PHYSICIANS

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Georgia (Mr. Gingrey) is recognized for 5 minutes.
  Mr. GINGREY. Madam Speaker, I rise again today, this week, to 
continue the discussion regarding the declining Medicare reimbursements 
for physicians. Effective January 1, 2004, physicians and other 
providers paid pursuant to the Medicare physician fee schedule face at 
least a 4.2 percent cut in reimbursements.
  For nearly 40 years, Medicare has provided necessary health care to 
those millions of patients across the country, some 40-something 
million this year. Another steep cut in reimbursement rates is now 
forcing many physicians who care for Medicare patients to make 
difficult choices. The scheduled January 1 cut in the reimbursement 
rate is just one of a string of Medicare payment reductions for 
physicians. Due to problems in the formula used to set Medicare 
payments for physicians, this 4.2 percent cut taken with the 5.4 
percent decline in 2002 contributes to successive pay cuts reaching 
more than 10 percent.
  To illustrate the Medicare payment history for surgical services, let 
us take a look at this chart comparing the Medicare economic index to 
physician payment update. The Center for Medicare and Medicaid 
Services, CMS, uses this Medicare economic index, or MEI, as a proxy 
for inflation in the cost of operating a medical practice. The largest 
component of the MEI is change in hourly earning for the general 
economy. A proxy for physicians' own time is in this index.
  Additionally, the MEI accounts for office expenses, medical materials 
and supplies, professional liability insurance, now that is a good one, 
professional liability insurance, and we know what is happening to 
that, medical equipment expenses and other benefits and various 
professional expenses.

                              {time}  2230

  Here the yellow line shows a steadily increasing MEI, up about 2 to 4 
percent every year starting in 1996. Every year extending out to the 
present time, a 2 to 4 percent increase.
  Now look at the red line. The red line charts an annual Medicare 
payment update for physicians resembling some sort of a roller coaster 
starting in 1996 and 1997 with surgical payments slightly under the 
MEI, and then in 1998 we have a tremendous drop. Look at this drop in 
1998, which rebounds the next year, the only year, I point out, that 
the MEI and the increase in payments are actually matched. Then we have 
a slight increase in physician payments until we start a disaster 
downward trend of payment cuts before congressional intervention in 
2003.
  When I look at this chart, it is clear to me that Medicare is not 
funded appropriately to ensure access to America's elderly and disabled 
patients. Without doctors' high levels of participation, the Medicare 
program would not have been able to serve millions of patients over 
these last 4 decades.
  Madam Speaker, I would like to read and include in the Record a 
letter I received just 2 days ago. Madam Speaker, the letter is from 
two doctors who practice in my home State of Georgia:
  ``Dear Representative Gingrey, although we continue to see Medicare 
patients in our practice, we are no longer accepting new Medicare 
patients. Further cuts in payments to physicians treating Medicare 
patients will undoubtedly result in a mass exodus of medical providers 
and secondarily limit access to medical care for the Medicare 
recipients.
  ``We have already noticed that many Medicare patients are having 
difficulties getting routine care. Despite the fact that we are 
physiatrists treating musculoskeletal problems, we find ourselves 
ordering routine care to working-up medical problems that their 
internists or primary care providers no longer have time to address. 
Unfortunately, we do not have the time to address these other issues 
either.
  ``Please help this situation by averting additional Medicare pay 
cuts.
  ``The courtesy of a response is appreciated.
  ``Sincerely, Amy M. Long, M.D. and Daryl L. Figa, M.D.''
  Madam Speaker, the courtesy of a response has been requested. What is 
our answer? Will we abandon those doctors who treat our most needy? 
Madam Speaker, we must stop, we must stop the 4.2 percent Medicare 
physician payment cut. Help our doctors help those who need their care 
the most. Madam Speaker, we must not forget doctors are the linchpin of 
the Medicare program.


                                                   OrthoRehab,

                              Lawrenceville, GA, October 13, 2003.
     Hon. Philip Gingrey,
     House of Representatives,
     Washington, DC.
       Dear Representative Gingrey: Although we continue to see 
     Medicare patients in our practice, we are no longer accepting 
     new Medicare patients for treatment. Further cuts in payments 
     to physicians treating Medicare patients will undoubtly 
     result in a mass exodus of medical providers and secondarily, 
     limit access to medical care for the Medicare recipients.
       We have already noticed that many Medicare patients are 
     having difficulties getting routine care. Despite the fact 
     that we are physiatrists treating musculoskeletal problems, 
     we find ourselves ordering routine care to working-up medical 
     problems that their internists or primary care providers no 
     longer have time to address. Unfortunately, we do not have 
     the time to address these other issues either.
       Please help this situation by averting additional Medicare 
     pay cuts.
       The courtesy of a response is appreciated.
           Sincerely,
     Amy M. Lang, MD.
     Daryl L. Figa, MD.

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