Medicare cut
to hurt seniors

Congress must act to avoid
a crisis, health officials say

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By Helen Altonn
haltonn@starbulletin.com

Medicare reimbursements to Hawaii will be cut 12 percent during the next three years, resulting in an estimated $34 million loss that will seriously reduce health care for seniors, Hawaii Medical Association officials say.

"Even at current fees, it's difficult," said Dr. Philip Hellreich, HMA legislative chairman and past president. "With further decreases in fees, it will be even more difficult for physicians to see Medicare patients and deliver services to the elderly."

Dr. Calvin Wong, newly elected HMA president, said payments should cover costs of services provided. "It's very difficult for health care providers, doctors and hospitals to take care of patients if there are cuts in reimbursements."

Medicare reimbursements are scheduled to be cut 5.4 percent this year alone.

Nationwide, physicians, nurses and other health care professionals caring for seniors face an $11 billion Medicare loss during the next three years, said the American Medical Association, urging a congressional halt to the next round of cuts Nov. 1.

"Unless Congress acts soon, more physicians will be forced to make the difficult decision not to accept new Medicare patients into their practices," said Dr. Yank Coble Jr., AMA president.

He said Medicare payments in 2005 will be below the 1991 level if nothing is done. Meanwhile, he said, physicians' costs are skyrocketing, especially medical liability insurance.

Wong, a cardiologist, said he has an office with all the costs of running a small business, which is very difficult to do in the present Medicare environment.

"Doctors are trying," Wong said. "We took an oath. We have a responsibility to the community. We need the community to rally around and help us with this issue."

Hawaii's doctors already are struggling to care for Medicare patients with reimbursements often below costs of services, Hellreich said. They're worse off than some of their mainland colleagues because of the high cost of living here, Hellreich said. Some states receive Medicare reimbursements based on cost of living, but not Hawaii, he said.

"We're really tied in with more rural areas. We're not getting the cost of living allowance we're entitled to," he said.

A survey last November of 522 doctors affiliated with the defunct Kapiolani Health medical plan revealed 45 percent didn't make enough money to cover rent and payroll in at least one month of the previous year. That rose to 60 percent for obstetricians and pediatricians.

According to a recent AMA survey, 24 percent of physicians nationally either have limited the number of Medicare patients they treat or plan to set limits in the next few months.

The AMA also found that 42 percent of physicians won't sign Medicare participation agreements if there are future cuts.

Hellreich said some of Hawaii's best qualified physicians, between 40 and 60 years old, are leaving because they can't afford to practice here. Shortages are occurring in specialties, such as rheumatology.

Wong said Hawaii's congressional delegation must seek a solution to the Medicare cuts. Someone also should represent Hawaii in seeking administrative help through the U.S. Department of Health and Human Services, he said.