Patients' Bill of Rights and Managed Care

October 7, 2002

The Honorable Richard Lugar                                      
United States Senate                                                                            
306 Hart Senate Office Building
Washington, D.C. 20510 

Dear Senator Lugar:

Immediate action is urgently needed in the Senate to ensure that America's physicians and other health care professionals can continue to provide elderly and disabled patients the care they deserve and depend upon.  Without such action, these practitioners will face a series of pay cuts so steep that many will be forced to limit their involvement with Medicare patients.  The undersigned organizations representing more than a million health care professionals therefore urge you to take whatever steps may be necessary to move legislation to avert these cuts through the Senate expeditiously.

Medicare payments to physicians and other health professionals were cut by 5.4% this year. Unless this crisis is addressed now, we expect a total of 12% in additional cuts over the next three years, beginning with a 4.4% cut that the Centers for Medicare and Medicaid Services (CMS) will announce in a final rule on November 1, 2002. The House has acted;  the Senate needs to act now.  Congress must send legislation immediately to the President to prevent further cuts.  

The physician update issue should NOT be labeled as a “giveback.”  The solution is a technical fix.  Congress never intended to roll back physician and other health care professional payment rates in the Balanced Budget Act of 1997 to 1991 levels. Unless Congress acts, Medicare payments to physicians and other health care professionals will be less in 2005 than in 1991. These cuts are a result of CMS' inaccurate estimates and formula flaws.  Simultaneously, practice costs will have increased 40% since 1991, due in large part to rapidly escalating costs for technology/equipment expenses, liability premiums, and regulatory burdens.

 Recent surveys and analyses reveal a serious erosion of patient access to care:

• Nearly one-third of physicians no longer accept all new Medicare patients. ¹
• 22% of family physicians no longer accept new Medicare patients. ²
• Nearly 40% of physicians have difficulty referring Medicare patients for needed services. ¹
• If 2003 rates show a similar decrease to 2002, 42% of physicians will refuse to sign Medicare participation agreements. ³
• Consumer advocates in more than half of states surveyed report trouble accessing Medicare physicians. ⁴
• In 2002, 8 states reported increased numbers of calls from people who could not find a Medicare physician willing to see new patients. ⁴
• Twice as many Medicare patients delayed care because they could not get appointments quickly enough. ⁵
• Patient access to care will only get worse if Congress fails to act.  Now the Senate must pass legislation that makes a multiple year commitment to positive payment updates that keep up with actual increases in physicians' and other health professionals' costs. 

We therefore implore the Senate to resolve this problem by including a solution in a legislative vehicle that will be enacted before November 1^st, 2002.

Sincerely,

American Academy of Audiology
American Academy of Child and Adolescent Psychiatry
American Academy of Dermatology Association
American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Family Physicians
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Otolaryngology - Head and Neck Surgery
American Academy of Pediatrics
American Academy of Physical Medicine and Rehabilitation
American Academy of Physician Assistants
American Academy of Sleep Medicine
American Association for Thoracic Surgery
American Association for Vascular Surgery
American Association of Clinical Endocrinologists
American Association of Clinical Urologists
American Association of Electrodiagnostic Medicine
American Association of Neurological Surgeons
American Association of Nurse Anesthetists
American Association of Orthopaedic Surgeons
American College of Cardiology
American College of Chest Physicians
American College of Emergency Physicians
American College of Nuclear Physicians
American College of Nurse-Midwives
American College of Nurse Practitioners
American College of Obstetricians and Gynecologists
American College of Occupational and Environmental Medicine
American College of Osteopathic Emergency Physicians
American College of Osteopathic Family Physicians
American College of Osteopathic Surgeons
American College of Physicians-American Society of Internal Medicine
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Geriatrics Society
American Medical Association
American Medical Group Association
American Nurses Association
American Occupational Therapy Association
American Optometric Association
American Osteopathic Academy of Orthopedics
American Osteopathic Association
American Physical Therapy Association
American Podiatric Medical Association
American Psychiatric Association
American Psychiatric Nurses Association
American Society for Clinical Pathology
American Society for Gastrointestinal Endoscopy
American Society for Therapeutic Radiology and Oncology
American Society of Addiction Medicine
American Society of Anesthesiologists
American Society of Cataract and Refractive Surgery
American Society of Clinical Oncology
American Society of General Surgeons
American Society of Hematology
American Society of Plastic Surgeons
American Speech-Language-Hearing Association
American Thoracic Society
American Urological Association
American Urogynecologic Society
Cleveland Clinic
College of American Pathologists
Congress of Neurological Surgeons
Infectious Diseases Society of America
Joint Council of Allergy, Asthma and Immunology
Marshfield Clinic
Mayo Clinic
Medical Group Management Association
National Association for Medical Direction of Respiratory Care
National Association of Social Workers
National Medical Association
National Organization of Nurse Practitioner Faculties
National Rural Health Association
North American Society of Pacing and Electrophysiology
North American Spine Society
Renal Physicians Association
Society for Cardiac Angiography and Interventions
Society for Excellence in Eyecare
Society for Vascular Surgery
Society of Critical Care Medicine
Society of Diagnostic Medical Sonographers
Society of Gynecologic Oncologists
Society of Interventional Radiology
Society of Nuclear Medicine
Society of Thoracic Surgeons
Society of Vascular Ultrasound

[1] “Results of the Medicare Payment Advisory Commission's 2002 Survey of Physicians,” Draft Final Report, Project, HOPE Center for Health Affairs, August 15, 2002

² “Number of Physicians Turning Away New Medicare Patients Jumps 28 Percent,” American Academy of Family Physicians Press Release, July 24, 2002

³ “American Medical Association's Medicare Payment Cut Survey,” American Medical Association, July 2002

⁴ “Medicare Facts and Faces,” Medicare Rights Center, Issue Brief, July 2002

⁵  “Growing Physician Access Problems Complicate Medicare Payment Debate,” Center for Health System Change, Issue Brief #55, September 2002