BY FRANK GLUCK
fgluck@news-press.com
The nation's physicians face a 21.2 percent cut in Medicare reimbursements starting Monday, a reduction local health care providers say could drive doctors out of this retirement-heavy region if left in place.
Rates are automatically set every year by a federal formula - around since the 1990s - that cannot be changed unless Congress steps in.
Because scheduled reimbursements have typically been lower, lawmakers have consistently blocked them.
But that had not happened as of Friday, prompting some in the medical community to envision the worst.
Dr. Douglas G. Henricks, a Fort Myers internist, shares a 5,000-patient practice that sees Medicare patients almost exclusively.
A 21.2 percent cut in payments would be devastating, Henricks said.
"If that happens, it would make our business decision simple," he said. "We would go out of business."
About 80 percent of the practice's budget covers non-salary expenses, Henricks said. The remaining 20 percent pays its four physicians and 30 other employees.
Another potential headache for doctors: The federal government often puts a temporary hold on Medicare reimbursements while decisions on rates are up in the air. The payment delays can last weeks.
Jim Nathan, president of Lee Memorial Health System, called the reimbursement formula one of several "ticking time bombs" in the nation's health care system.
Continued worries about potential cuts make it difficult for physicians to budget in Medicare-heavy markets, he said.
About 44 percent of system patients are on Medicare. The reductions would cost system-employed physicians in excess of $6 million a year.
That high share of Medicare patients is not likely to change anytime soon in this area, the economy of which is largely based on older people migrating here, Nathan said.
"Even if the economy continues to rebound, I can't see the number of commercially insured rebounding," Nathan told system officials this week.
The federal Medicare reimbursement schedule was created to help control costs as part of the 1997 Balanced Budget Act.
It has called for cuts since 2002.
The federal agency that administers Medicare and Medicaid held off on reimbursement reductions in 2003, and Congress has blocked them since 2004.
"The president has repeatedly stated his commitment to changing the formula," Ellen B. Griffith, spokeswoman for the Centers for Medicare & Medicaid Services, said Friday. "Unfortunately Congress has not yet enacted a long-term solution that would provide permanent reform to the Medicare payment system for physician services."
The House voted this week to postpone the cuts.
The measure in the Senate is attached to a bill extending unemployment benefits currently being blocked by Sen. Jim Bunning, R-Ky.
A spokeswoman for Rep. Connie Mack, R-Fort Myers, did not immediately respond to a request for comment Friday afternoon.
The scheduled cuts are widely expected to eventually be put off again.
"This has always been threatened, and it's always been canceled at the last moment," said Dr. Stephen Zellner, a physician for Internal Medicine Associates in Fort Myers.
The practice has about 120,000 patients in Lee, about half of whom are on Medicare, Zellner said.
He said he's heard some physicians say they would close up shop if the cuts are not rescinded - though many would likely continue out of dedication to the profession, he said.
"That's what the government's banking on - that the doctors won't strike and walk away, because they've never done it before," Zellner said.
