Doctors: Trouble not over yet

Doctors are already filing for reimbursements under the new rates granted by the Medicare Improvements for Patients and Providers Act of 2008, but local physicians say the problems are far from over.

"The country as a whole has got to figure out some way to solve this (health care) crisis, and, for the life of me, I don't know what it is," said Dr. Tommy Yates, a pathologist at Eliza Coffee Memorial Hospital in Florence and president of the Lauderdale County Medical Association.

"We all have our ideas, but the train has left the station. It was wobbling hard at the first of July, and, right now, it's not, but there's still trouble ahead."

In the Shoals, some internists and primary care physicians were forced to stop accepting new Medicare patients as the Centers for Medicare and Medicaid Services ceased reimbursements all together as the act made its way through the legislative process. Reimbursements resumed July 15 after the bill became law and the rate schedule was confirmed.

In its original form, the bill would have cut reimbursements to physicians by more than 10 percent, making it difficult for doctors who primarily treat Medicare patients to continue operating a financially viable practice, Yates said.

In the form that passed, however, the House and, eventually, the Senate after overriding a presidential veto, approved the bill that will increase reimbursements by .5 percent for the rest of 2008 and by 1.1 percent in 2009. U.S. Reps. Bud Cramer, D-Alabama, and Robert Aderholt, R-Alabama, voted in favor of the measure, while Republican Sens. Jeff Sessions and Richard Shelby voted against it.

"Anytime they don't make the relief permanent, it just becomes a temporary fix," Yates said. "My understanding is that, in 2010, we're looking at the possibility of another cut, so we could go through this again."

Estimates are that cuts to physicians could be as much as 20 percent.

Other components of the bill that Yates said could prove helpful to the overall health care in the Shoals are the support it offers to rural health care and the lower fees it provides for mental health care for seniors. Additionally, the act helps keep insurance premiums from going up for low-income seniors.

Local hospitals, ECM, Helen Keller in Sheffield and Shoals in Muscle Shoals, won't fare as well under the legislation that passed because it does little to help increase Medicare reimbursements to them, said Carl Bailey, chief executive officer at ECM.

"We're all seeing growth in the number of patients we treat who are really sick and a decline in the number of patients who are kind of sick, and our overhead is such that we have to have a mix of both to survive," he said. "This measure hurt hospitals badly."

One thing physicians and hospitals agree on is that something more permanent is needed to mend the health-care situation in the country that has its roots in the Johnson administration when Medicare was established.

Dr. Michael Gosney, medical director of the Shoals Pain Center in Sheffield, said the issue is important to every American and he foresees another temporary fix until there can be an overall revamping of the reimbursement system or a debate about a national health-care system.

"Times have changed, and people are going to have to change," he said. "If health care is that important to us, we're going to have to start making healthier choices. I have a stake in health care for the elderly because I'm there. I'm seven years away from Medicare, and I was in my teens when I got my first job, so I've paid into the system my whole employed life."

Gosney points to the rallying cry of seniors across the country who may have been denied treatment as Medicare patients, making the national insurance system they've paid into throughout a lifetime meaningless at a time when it is most needed.

Already, more than 40 million Americans take advantage of the Medicare system to pay for medical treatment, but that number is expected to rise as the number of baby boomers retire in the coming years and threaten to further strain the system.

Without a national health-care plan on the horizon, more money in the system may offer the only solution if access to quality medical care is to continue, Gosney and Yates contend.

"If there are 40 million people who use Medicare and only a small fraction who are physicians who care for them, you will be forced to cut either their access to care or cut the reimbursements to people who care for them, and then we'll have a huge problem," Yates said.

Michelle Rupe Eubanks can be reached at 740-5745 or michelle.eubanks@TimesDaily.com.