Congress keeps Medicare doctors waiting

By Julianne Pepitone, staff reporter


NEW YORK (CNNMoney.com) -- As lawmakers tussle over freezing a 21% cut to doctors' Medicare fees, physicians are stuck waiting for word as to how much they'll be paid -- and when.

Officially, a massive cut to the rates that the government pays doctors to treat Medicare patients took effect June 1.

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Medicare doctor Scott Nelson's revenue is down 20% compared with last year at his Cleveland, Miss. practice.
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Dr. Guy Culpepper was forced in March to drop his Medicare patients after 23 years.

But the Centers for Medicare & Medicaid Services said it would delay processing claims for 10 business days, in the hope that Congress will delay the cuts, making the move retroactive, as it has done for years.

But Monday, June 14, marks the 10th business day of that claims delay -- and lawmakers are still locked in a stalemate while doctors go unpaid.

The House of Representatives voted May 28 to delay the 21% pay cut for 19 months, but the Senate did not take action before its Memorial Day recess.

The Senate discussed its version of the so-called "Doc Fix" on Tuesday, which would give doctors a small boost in rates for the next two years instead of just delaying the rate cut.

But it's unclear whether a bill will pass. Meanwhile, doctors are left wondering how they'll care for their 43 million Medicare patients.

From a dream to a nightmare

"Caring for these patients was my lifelong dream," said Dr. Scott Nelson. "Now, it's become a nightmare."

Born and raised in the Mississippi Delta, Nelson returned after medical school to his hometown: bucolic Cleveland, Miss. But now the family physician is struggling to continue caring for the Medicare patients who make up about half of his 400 monthly visits.

"Here in the rural south, there are a lot of impoverished people who really need Medicare," Nelson said. "[Congress] is taking a reactive approach instead of being proactive, and we doctors are left confused."

Even before the current cuts, Nelson said his practice's revenue is down 20% year-to-date compared with this time last year. And the delays in processing Medicare claims mean that he'll have to wait even longer to be paid for services he's already rendered, he said.

Now, faced with a fee cut, Nelson wonders not only how he can keep his doors open -- but also how new doctors will be lured to places like the Mississippi Delta, where their services are sorely needed.

"They always say, 'We need to get doctors to come home to rural America,'" Nelson said. "But why would they want to?"

'The hassle got to be too much'

As uncertainty abounds, the American Medical Association says 60% of Medicare doctors are considering opting out of the program in order to stay afloat.

Dr. Guy Culpepper, a family physician in the Dallas area, said he was forced to make the "gut-wrenching" decision to drop his Medicare patients in March.

Though Culpepper accepted Medicare starting on his first day in practice in 1987, he said the constant threat of fee cuts and paperwork headaches left him with no choice.

"Lawmakers don't appreciate us -- they hassle us and then they lower our payments," Culpepper said. "Now Congress doesn't respect us enough to talk it out and fix the problem."

Culpepper also points out that a Medicare rate cut would have a ripple effect, because private insurers use Medicare fees as a benchmark to determine their own reimbursement rates for medical services. For example, a private company may pay doctors 115% of the Medicare rate.

"It ended up costing me money to see a Medicare patient," Culpepper said. "Being a doctor is always a labor of love, but this has been heartwrenching." To top of page

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