North Bay doctors say temporary fix doesn't solve Medicare problems

North Bay doctors said the deal struck Thursday in Congress does nothing to resolve a fundamental problem with the Medicare system, which provides health care to millions of senior citizens across the country.

Two months from now, doctors in Sonoma County and the rest of the United States will once again face a 27 percent cut in payments for treating Medicare patients.

House Republican leaders on Thursday agreed to support a deal Thursday that would postpone the Medicare cuts for two months, part of an agreement to temporarily reduce the Social Security payroll tax and extend unemployment benefits.

Without the temporary fix, the Centers for Medicare and Medicaid Services, which runs Medicare, had warned it would not process any Medicare claims by physicians between Jan. 1 and Jan. 17.

It's a doomsday scenario that has become a perennial headache for local doctors.

"Now we're arguing over a two-month fix. It's just a waste of everybody's time. We should get it fixed," said Dr. Jeff Sugarman, president of the Sonoma County Medical Association.

The Medicare cuts are mandated by a formula called the "sustainable growth rate," or SGR, which uses a targeted growth rate tied to gross domestic product growth, physicians' costs and Medicare enrollment changes. If Medicare spending exceeds SGR targets, Medicare rates for the following year are adjusted down.

But critics of the formula, which became law in 1997 as part of that year's Balanced Budget Act, say SGR underestimated the skyrocketing cost of health care. Every year since 2003, Congress has put off the Medicare reimbursement cuts mandated by SGR. And every year, the accumulated cut gets bigger.

"At this point, they've created a monster," Sugarman said. "Now it's a 27 percent paycut, which is really untenable."

Dr. Brad Drexler, a private practice OB/GYN with offices in Healdsburg and Santa Rosa, said the SGR formula does not take into account the dramatic growth rate of the senior population, how sick they are and the cost of new technologies.

Add to that Sonoma County's designation under federal guidelines as a "rural" community, which means local doctors are reimbursed at a lower rate than doctors in counties designated as "urban," such as Napa, Marin and San Francisco.

Earlier this week, after House Republicans rejected the Senate's bipartisan deal over the payroll tax cut extension, Dr. James Hay, president of the California Medical Association, said in a statement that such a cut would force doctors to "lay off staff, reduce services offered and in some worst case scenarios, close their doors altogether."

Drexler said that a California Medical Association survey of doctors in 2008 found that 40 percent of physicians would no longer accept Medicare if current mandated cuts were implemented.

Under such a scenario, seniors and disabled who are on Medicare would face similar challenges that Medi-Cal patients face — finding a doctor to treat them.

Sugarman said that some doctors, particularly those between 58 and 65, could simply retire and leave the business altogether.

"I think you're going to see a lot of doctors say, &‘This isn't worth it anymore,'" he said.