"We won't change how we treat Medicare patients of course, because we're mission-bound to treat everyone equally," said Dr. Lee Green of the University of Michigan's Department of Family Medicine. But, he added, "This will be an absolute fiasco for primary care physicians nationally... I can't imagine a more destructive thing for Congress to do in the current state of our health care system. To be blunt, I consider this a management failure on the part of Congress, irresponsible bordering on reckless."
Part of some lawmakers' ambivalence to support delaying the cuts could be concern over deficit spending. The Congressional Budget Office estimates that over the next two years, such a fix would tack an additional $22 billion to the federal deficit.
The cuts in reimbursement actually stem from a formula based on the sustainable growth rate, or SGR, a program Congress set up in the 1990s that tied the payments doctors received for treating these patients to the GDP. But even though the cuts were scheduled to take effect at the turn of the millennium, a series of quick fixes have pushed the schedule back.
In the meantime, under the threat of such cuts, physicians have been forced to balance their duty to serve patients against the pressure not to be the last center available to Medicare patients. In this game of musical chairs, the last practice standing could get walloped with a flood of low-revenue Medicare patients -- a hit that Fields said could risk destroying a practice.
Some doctors anticipate that this threat will force them to change the way they conduct their practices -- and for some, the changes have already begun.
"I have not taken new Medicare patients for two years in anticipation of this very event," said Dr. Marsha McKay, a family physician in Twain Harte, Calif. "If it becomes a permanent 21 percent cut, I will change to no longer taking assignment for Medicare and will be able to balance bill my patients for their visit. If I don't, I will be paying about $23 to see them each time."
Dr. Neil Brooks, a geriatrician who works at a nursing home and rehabilitation center in Vernon, Conn., said doctors like him who treat older patients will be particularly affected.
"In the short term I will continue to see Medicare patients, but if the cut is instituted and maintained I would most likely be forced to discontinue my current practice," Brooks said. "That would sadden me because I enjoy what I do and believe that I do it well. I would suspect that it would also sadden the many patients for whom I care."
Dr. Randy Wexler, assistant professor of Clinical Family Medicine at Ohio State University, said that he has begun accepting Medicare patients who come from one to two counties away due to the fact that many family physicians have closed down altogether -- not just to Medicare patients.
And he said that doctors' patience is running out.
"This on-again, off-again, 10-day, two-week, two-month or whatever delay is very much hurting the ability of physicians to run a practice," Wexler said. "This is no longer a Republican or Democrat issue. Congress and the White House have finally generated bipartisanship. Physicians are equally angry at both parties."