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Oct. 17, 2011
TOPEKA The budget-cutting work of the congressional Super Committee brings a new set of uncertainties for Kansas doctors.
“We are watching the Super Committee closely, but it’s not just the Super Committee. It’s kind of everything else,” said Jerry Slaughter, executive director of the Kansas Medical Society. “There are a lot of moving parts right now as it relates to Medicare and Medicaid.”
Slaughter said he’s been telling society members to expect at least a 2 percent cut in Medicare reimbursements. “And economically things have gotten worse, so it’s sort of a double whammy, if you will,” he said.
Of equal or greater concern to doctors, Slaughter said, is what Congress may or may not do about the so-called “doc fix,” which would revise or eliminate the Sustainable Growth Rate (SGR), a measure Congress enacted in 1997 with the goal of controlling government spending on physician services.
The SGR would mean about a 30 percent reduction in Medicare doctor payments beginning Jan. 1, if Congress follows the formula set in the Balanced Budget Act of 1997.
Congress has rarely followed the formula since it was created, but doctor groups would like to see the SGR written out of law entirely. They are especially worried about it now that Congress is so focused on cutting the deficit.
“No one believes they're going to cut payments to doctors by 30 percent,” Slaughter said, “because you'd have a pretty dramatic flight of doctors away from the program. ... But the potential is very realistic for a cut of at least 2 percent and maybe more, particularly for folks in some of the specialties.”
More uncertainty looms at the state level as the administration of Gov. Sam Brownback prepares to release its plan for making over the state Medicaid program.
The administration has said it wants to significantly reduce Medicaid spending. Slaughter said one of the few realistic options for doing that, given current federal restrictions on states, is reducing the rates paid to doctors and other providers.
“The same time as the Super Commitee is meeting and the SGR question is hanging, you've got this thing in another significant program (Medicaid) that covers 350,000 Kansans,” he said. “I don't know where they'll find the savings in the short run without cutting providers. We don't support it, and I don't think the administration supports it. I think the last thing they want to do is cut provider payments. That would harm access to care. But the provider community is concerned that there may not be any other choices.”
Meanwhile, many doctors are investing in electronic health records with no certainty the new systems won’t add to instead of cut costs. And there is the national uncertainty about what will become of the federal health reform law, which faces a challenge before the U.S. Supreme Court.
“There’s a really oppressive air of uncertainty about what's going to happen to these public programs,” Slaughter said.
Yet more uncertainty exists about the outcome of a Kansas Supreme Court case challenging the constitutionality of a state law that caps the damages that can be awarded to victims of medical malpractice. The court has been reviewing the case for more than two years, an unusually long time.
“If they strike that law,” Slaughter said, “malpractice premiums for doctors will at least double.”
Slaughter said a sharp increase in malpractice premiums coupled with decreases in government payments could push doctors, especially those nearing retirement, to get out of the business.
“A number of things, all taken together, have created this uncertainty and frustration,” he said.