Providence, R.I. – This week, doctors across the U.S. were hit with a 21 percent decrease in the amount they receive from Medicare. The pay-cut is a result of a Medicare funding law passed years ago.
Since then, Congress has made a tradition of passing temporary legislation to delay the pay-cuts - which is precisely what lawmakers did last night. They passed a bill to postpone the reductions, but once again they failed to permanently fix a problem that continues to frustrate doctors like Pawtucket physician David Carter.
Carter is family physician who's been greeting his patients with a warm smile and a jaunty bow tie for thirty years. Awards and certificates of recognition cover an entire wall of his Pawtucket office, from the ceiling all the way to the floor. He points to one of them-an award from the American academy of family physicians, awarding him the honorary title of "Jolly Good Fellow."
But Dr. Carter doesn't feel jolly about the way the federal government has threatened a large pay cut year after year, only to delay it at the last minute. He depends on government payments to keep his practice open- athird of his patients are on Medicare.
"These poor people have to be concerned that I may turn them away, and say I can't afford to see you," he said. "I can't afford to take a 21 percent reduction in pay. I may not be able to afford my bills and that would put us all out of business."
This month, Congress waited too long to delay the payment reduction. On Monday, doctor's payments started reflecting a 21 percent pay cut. Then, with last night's action, Congress voted again to delay the reduction temporarily.
The problem started In 1997, when Congress passed a law to help control the cost of Medicare. The legislation said the Medicare payments doctors receive should grow no faster than the growth of the economy.
But that formula didn't work, according to Amal Trivedi, a professor of Community Health at Brown University's Medical School.
"Since that time, health care inflation has far outpaced economic growth," he said. "Essentially every year since 2002, the congress has had to come back and find out a way to not go through with the payment cuts that were stipulated by the 1997 balanced budget act."
That's because the cuts would be difficult for doctors who depend on Medicare payments. So for years, again and again, congress has delayed its own rules with something called a "doc fix." And every time Congress delays the reduction, the amount it would have to cut to comply with the law gets bigger. So every year the stakes get higher for doctors like Dr. David Carter, who face a perennial threat of a big pay cut.
Carter says it's time for a permanent fix, one that guarantees fair, consistent payments. And based on the comments before the vote last night, members of Congress agree. Republicans and Democrats all called for a long term solution. So why hasn't it happened yet?
A short term fix is much cheaper than a long term fix. Professor Trivedi estimates the cost of fixing the Medicare payments over ten years will be around 250 billion dollars, so it's unlikely Congress will fix the problem any time soon.
Meanwhile, physicians like Dr. David Carter are losing their patience.
"At a certain point you shrug your shoulders and say, is it all worth it?" Carter said. "After 30 years, maybe I should just say the heck with it, and we'll get out of business. "
Dr. Carter now has until the end of November before he'll face another potential pay cut. But Dr. Carter says he'll be doing something else that month- working to elect representatives who will fix the problem for good.