Medicare cuts leave doctors few options.

Byline: GUEST VIEWPOINT By William Plested and Donald Schroeder For The Register-Guard

As Oregon's popularity increases among retirees, more than half a million patients in Oregon now rely on Medicare to provide vital health care services. But Jan. 1, Medicare patients' access to care will be jeopardized by the first of many steep cuts in Medicare reimbursements to physicians. Without immediate congressional action, Medicare will cut physician payments by 37 percent automatically over the next nine years, while practice costs will increase at least 22 percent.

Nearly half - 45 percent - of physicians say they will take fewer new Medicare patients, or stop taking new Medicare patients altogether, if the first of the Medicare cuts goes into effect next year. That's frightening news for seniors who rely on Medicare to get the health care they need.

Medicare currently reimburses physicians at about the same rate as in 2001 - that's in real terms, not adjusted for inflation. Seniors already are beginning to feel the impact of the government's foolhardy payment scheme. A report by the commission that advises Congress on Medicare shows that 25 percent of Medicare patients seeking a new primary care physician are having trouble getting an appointment already.

Deep cuts will only make matters worse. For the seniors who rely on Medicare for health care now, and for the first wave of baby boomers who age into Medicare in the midst of long-term cuts, there's a real concern that there won't be enough doctors to care for them.

Physicians who try to continue to take new Medicare patients, face many difficult decisions. Seventy-three percent told the American Medical Association they plan to defer purchase of medical equipment, and 65 percent plan to put off buying information technology.

Physicians make these difficult practice decisions with great reluctance. After all, physicians are first and foremost healers. But the economic reality of year after year of cuts leaves doctors with few options. Over the next nine years, Oregon will lose $1.3 billion in federal funding that should go toward caring for the state's seniors.

Our greatest fear: Medicare patients will lose access to dedicated doctors as they are forced to change the way they practice medicine. This is no idle concern. In addition to the AMA findings on physician reaction to the Medicare cuts, a national survey by a physician recruiting firm found that more than half the physicians between the ages of 50 and 65 plan to take steps in the next one to three years to take themselves out of the patient care setting or reduce their caseload.

Forty-five percent of physicians who practice in Oregon are older than 50. Coupled with a predicted shortage of 85,000 doctors by 2020, the future for seniors' access to care is bleak - unless we take concrete steps to turn the tide.

Congress has the ability and the authority to set Medicare on the right course for the future. It can face the challenge and preserve seniors' access to care by stopping the cuts and by tying physician payments to increases in practice costs.

Congress recently took an important step in the right direction. Eighty senators, including Democrat Ron Wyden of Oregon, recently sent the Senate leadership a letter urging action before Congress recesses in October, and legislation that addresses the issue has been introduced in the House.

There's a small window of time open for Congress to do the right thing. If it doesn't, seniors will pay the price of their inaction.

Dr. William Plested is president of the American Medical Association. Dr. Donald Schroeder of Eugene is past president of the Lane County Medical Society, past president of the Oregon Medical Association and a delegate to the AMA.