Dear Valued Patient,
Medicare is the program that provides health insurance for most older Americans. Whether you, a family member or a friend has Medicare coverage, what happens with Medicare affects all of us ultimately and directly. In addition, you may know someone who gets insurance through TRICARE, the program that covers members of the military and their families. There is a serious and fundamental problem with Medicare that impacts TRICARE patients as well, and I’d like to ask your help in getting it fixed. This will mean your writing your U.S. Representative and your U.S. Senators in Congress.
Here’s the problem. Right now, the federal government pays physicians like me for health care services provided to my Medicare patients using a complicated formula that is out of date. This formula, called the “Sustainable Growth Rate” (SGR), is based on U.S. economic factors that are not related to the cost of patient care. The formula was put into place many years ago to save on health care costs, but it no longer works or makes sense. It isn’t based on older people’s health care needs, or on how much it costs to keep my practice up and running. When the government uses this formula, I effectively get paid less and less every year because the formula does not keep pace with the cost of providing services. And since the payment rate for TRICARE health insurance program for military members and their families also is based on these rates, this issue affects the health care of military families as well.
For example, right now, I pay my staff 2010 wages. I pay for electricity, heating and water at 2010 rates. I buy medical supplies and equipment at 2010 prices. However, the government is paying me to care for Medicare patients at rates equivalent to those of 2001. I will not be able to keep this up for long. If changes do not occur this November, I will be forced to drop all Medicare and TRICARE insurance.
The U.S. Congress has to change federal law to fix this formula. The federal Medicare Payment Advisory Commission has recommended that Congress replace the old formula with a new one based on realistic and relevant information. Unfortunately, each year, rather than fixing this complicated formula, Congress has voted to postpone real reform to the system. This has happened many times over the past few months, so I knew what payment I would receive for caring for my Medicare patients for only a few weeks at a time.
In fact, I received no payments for Medicare visits for the entire month of June, 2010, until mid-July. I know of no other business that can function without getting pain for services until 1-2 months after the services are rendered.
Here’s what Congress needs to do to solve the problem:
• Permanently fix the SGR formula.
• Provide better payment in that formula for primary care physicians, who are the doctors who coordinate health care for the whole person at every age, not just for a certain body part or particular age group.
Here are a few closing thoughts for you, as my patient:
• Yearly or monthly Medicare payment cuts — nearly 30 percent next year due to this formula — create an unstable program for everybody: patients and doctors.
• Because of the financial strains that these cuts impose on many physicians’ practices, they may be forced to stop seeing Medicare patients. This will make it more difficult for new Medicare patients and even some current ones to find a primary care doctor who can provide them needed care. Elderly people should not have to worry about their health care.
• Many of America’s family physicians are small businesses. We are very committed to our patients but, like you, we need to make enough money to stay afloat.
I would deeply appreciate it if you could send a letter to your U.S. Representative and your U.S. Senators on this issue.
There are two easy ways you can do this:
• Go to http://capwiz.com/aafp/go/patients, enter your zip code and email a letter from you to your U.S. Senators and U.S. Representative.
• If you’d like, my office can fax the letter for you while you are at the office.
Thank you very much for your help in keeping me in business.