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practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.


Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.


Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.96


Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.97


Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”


We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment providers, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.


Medicare patients 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 millions of patients dependent on Medicare, the program will not work.


January 2013 TEXAS MEDICINE 61


Repeal the Independent Payment Advisory Board


Replacing the SGR will be meaningless unless Congress also repeals the Independent Payment Advisory Board (IPAB). Leaving both in place would create cruel and unusual double jeopardy for physicians who want to care for senior citizens and military families. The PPACA created a 15-member IPAB to recommend measures to reduce Medicare spending if costs exceed targeted growth rates set by the Centers for Medicare & Medicaid Services.


The PPACA prohibits the panel from recommending changes to eligibility, coverage, or other factors


A PHYSICIAN’S STORY


C. Bruce Malone, MD Austin


Medicare Meltdown


“We’re just asking the government to fix a problem they’ve had an opportunity to fix for 10 years. I’m not blaming one party or another because both parties have had an opportunity to fix it and haven’t. Long term, it’s going to affect every patient, not just Medicare. Long term, if your doctor can’t balance his practice and keep it open and healthy, he may not be there for you, even though you’re 35 years old.”


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