don’t make a good faith effort, how do you go about resolving that situation?” But Mr. Geeslin stands behind the fi-


nal product.


“I think it’s going to require everybody to make some changes, as a lot of rules do,” he said. “But, ultimately, the true test will come in May of 2012. I’ll let the facts speak for themselves at that time.”


we didn’t think the number would be that high. Even considering a possible ‘compromise cut’ of 10 percent, physi- cians’ responses were the same — they would leave Medicare,” he said.


Repeal SGR


Uncertainty threatens to force Texas physicians from Medicare program


Ongoing uncertainty over Medicare payments to physicians — including a 29.5-percent across-the-board cut sched- uled Jan. 1 — is forcing half the phy- sicians in Texas to consider leaving the program, putting seniors, military fami- lies, and Texans with disabilities at risk of losing their doctor. A new Texas Medical Association sur- vey shows 50 percent of Texas physicians are considering opting out of Medicare, while 51 percent may change their sta- tus to nonparticipating if Medicare cuts their payments almost 30 percent. Fort Worth anesthesiologist Albert


C. Bruce Malone, MD


Shaw, MD, says he’s done. “It breaks my heart and haunts my soul. However, I have no choice, if I’m to stay in business,” Dr. Shaw said, a senti- ment echoed by hundreds of physicians who responded to the survey. “The number of Texas physicians who may be forced to leave Medicare if Con- gress doesn’t fix the program is stag- gering,” said TMA President C. Bruce Malone, MD. “It’s tragic. Medicare sim- ply cannot work without physicians to care for the mil- lions of patients dependent on it — Congress can’t wait any longer.” “We knew some physicians would consider leaving the program, but


The only way to stop the pending Jan. 1 cut is for Congress to fix the defective formula used to pay physicians. Federal law adjusts Medicare payments to phy- sicians annually using the Sustainable Growth Rate (SGR) formula. Because of a flawed design, the formula has man- dated physician fee cuts every year for the past decade.


Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress intervened five times to stop a 25-percent cut. Without a permanent solution, the size of the cuts continues to grow.


During this same time, hospitals, skilled nursing homes, home health agencies, and inpatient rehabilitation facilities all received pay increases. TMA believes at a minimum, Congress should not allow these health care providers to receive another payment increase until they fix the broken physician payment system. To compound matters, if the congres- sional Joint Select Committee on Defi- cit Reduction can’t trim $1.2 trillion in federal spending by Thanksgiving, phy- sicians will face an additional 2-percent cut to their Medicare payments begin- ning in 2013. A 2-percent cut in addition to the looming 29.5-percent cut would be dev- astating for physician practices. Dr. Malone said that “Medicare pa- tients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the mil- lions of patients dependent upon Medi- care, the program will not work.” “The last thing we want to do is abandon our elderly patients,” said Dr. Malone, an orthopedic surgeon who has practiced in Austin for 37 years. “How- ever, I might not have a choice but to retire early. Over half of my practice consists of Medicare patients.” Last year,


his medical group reduced staff to help make ends meet. Congress has delayed solving the


problem for 10 years. “Now, due to its inaction, the stability and long-term vi- ability of Medicare is threatened,” added Dr. Malone.


The gaping problem has eroded ac- cess for both Medicare and Medicaid pa- tients. More than one-third of primary care physicians and physicians who work in rural areas of the state already limit the number of new Medicare patients they can accept. Medicare uncertainty also affects Medicaid patients. A third of Texas phy- sicians limit the number of new Medic- aid patients. And Medicaid access would suffer even more if Congress lets the cuts go through: More than one-quarter say they will impose more Medicaid limits if the cuts go through; another 27 percent are considering such limits.


About the survey In August, TMA surveyed physicians to better understand how a 10- or 29.5-per- cent cut would impact Texas physicians and their patients. The analysis includes answers from 1,906 respondents who took the survey. TMA emailed invitations to participate in the online survey to all 32,797 TMA member and nonmember physicians for whom the association has email addresses. The response rate was 6 percent. Demographically, the respondents reflect the makeup of the entire TMA on the basis of age, gender, specialty, member type, and geographic location.


Medical liability suits continue to decline under 2003 reforms


The number of medical liability claims and lawsuits continue to decline across Texas, while the number of counties gaining specialists such as obstetricians, emergency physicians, and cardiologists continues to rise, according to the lat-


November 2011 TEXAS MEDICINE 35


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