Sen. Bob Corker

Tennessee doctors are frustrated with a vote by the state’s U.S. senators against taking action on a bill that would have reversed a 10.6 percent cut in Medicare payments to physicians.

But the senators, Bob Corker and Lamar Alexander, both R-Tenn., said they voted to put off action on the bill to protect Tennessee hospitals.

Last week’s vote in the Senate failed by one vote to invoke “cloture,” which would close debate and force a vote on the bill. A “yea” vote from either Sen. Corker or Sen. Alexander would have made a difference, physicians in Tennessee point out. The legislation passed overwhelmingly in the U.S. House of Representatives.

“I’m very disappointed in the senators,” said Dr. Andrew Vernon, a local pulmonologist and sleep doctor. “We are struggling to try to make this business successful, and something like this (cut) would be absolutely devastating for us and for every person in private practice, as well.”

Almost 60 percent of Dr. Vernon’s patients are on Medicare, and a cut in payments of this magnitude would make it difficult for his practice to stay afloat, he said.

A survey of almost 9,000 doctors by the American Medical Association last summer found that if 10 percent cuts to reimbursements are implemented, 60 percent of physician respondents plan to limit the number of new Medicare patients they treat.

“This may be the straw that broke the camel’s back,” said Dr. Robert Kirkpatrick, president of the Tennessee Medical Association and a Memphis physician.

Staff Photo by Dan Henry
Dr. Andrew Vernon prepares to examine 69-year-old Medicare patient James McDowell at the Specialists in Pulmonary Care and The Chattanooga Sleep Center facility off of McCallie Rd. Tuesday afternoon. Dr. Vernon is a local doctor who is frustrated about a potential 10.6 percent cut in Medicare payments to physicians.

In a telephone interview this week, Sen. Corker said his vote against taking action on the measure primarily had to do with the bill’s failure to provide out-of-state Medicaid funding to the Regional Medical Center at Memphis.

The Memphis safety-net hospital is struggling since it now does not get reimbursed for the Medicaid patients it treats from Mississippi and Arkansas, Sen. Corker said.

“I knew that the (Bush) administration had the ability to keep these cuts from coming into play (until July 15), and I voted the way I did hoping when we get back on Monday we’ll still have the opportunity to sit down and negotiate this provision,” he said. “I think 99 percent of the physicians, if they knew what I was doing ... would thank me.”

The cut in Medicaid payments, originally scheduled to go into effect July 1, was postponed by the Bush administration to give Congress a chance to revisit the legislation when members return next week from the Fourth of July holiday.

Instead of processing payment claims from doctors, the U.S. Centers for Medicare and Medicaid Services will hold doctors’ claims for 10 business days, giving Congress until July 15 to pass a bill.

Sen. Alexander agreed with Sen. Corker in a written statement that said, in part, “I could not vote for this version of the Medicare bill because it is not fair to Tennessee hospitals, especially the Regional Medical Center at Memphis.”

Rae Bond, executive director of the Chattanooga and Hamilton County Medical Society, said she understood the difficult position of legislators trying to balance the needs of various constituents.

But, she said, “there are a number of bills that deal with hospital funding and, in fact, hospitals are not facing the cuts that doctors are facing. I think in the physician community there’s great frustration that those two issues were linked in that particular bill.”

IMPACT OF CUTS

Cuts to Medicare rates would have a snowball effect on payments from private insurers, who base their payments on Medicare’s fee schedule, said Ms. Bond of the local medical society.

“If there’s a cut in the Medicare rates, and if (private) insurers follow suit and also cut their rates, it would have a catastrophic impact on most practices,” she said.

National legislators also have been stuck over the issue of how to fund an increase in payments for physicians. President Bush has threatened to veto the Medicare bill since it would fund the payments to doctors in part by taking away money from insurance companies that administer private Medicare Advantage plans.

About 20 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, which pay insurance companies on average about 113 percent of traditional Medicare payments, according to the Medicare Payment Advisory Commission, an independent congressional agency that advises Congress on the Medicare program.

“The interesting fact is that both sides, Democrats and Republicans, both know (averting the cuts to doctors) is the right thing to do. ... But they can’t get their arms around a fix for it,” Dr. Kirkpatrick said.

The American Medical Association has vowed to run radio and television ads all week in a number of states, including Tennessee. One ad states, “A group of U.S. senators voted to protect the powerful insurance companies’ huge profits at the expense of Medicare patients’ access to doctors.”

Sen. Corker expressed his disappointment in the “disingenuous” ad, which he said mischaracterizes his vote as related to support for Medicare Advantage programs.

“I am probably one of the few Republicans who actually has strong concerns about the way we are dealing with Medicare Advantage,” he said. The AMA officials “know that, they have acknowledged that and yet they continue to run this ad.”

Dr. Nancy Nielsen, president of the AMA, said the ad references President Bush’s threatened veto over the Medicare Advantage issue and is intended to spread awareness about the impending re-vote on the bill.

“I’ve never had physicians as angry, upset, disappointed, outraged as I’ve seen over this one. I think it’s because we go through this every year with Congress ... and it’s tipped people over the edge, really,” she said.

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