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AARP Wins Victory in Protecting Access to Medicare Doctors

Floridians 65+ in Medicare could breathe a sigh of relief in December when Congress acted to protect your access to your doctor in Medicare for a full year.    

If Congress had not acted, physicians in Medicare would have suffered a devastating 25-percent reduction in payments for providing care to Medicare beneficiaries on Jan. 1.

Fortunately, in swift, bipartisan votes in early December, members of the U.S. House and Senate approved a one-year extension that protects seniors’ access to Medicare doctors for a full year by extending current payment rates. However, if Congress does not act in late 2011, seniors’ access to Medicare doctors will once more be at risk – and the uncertainty of future funding already is having an impact on doctors’ willingness to treat Medicare patients. Already the number of Florida doctors who accept Medicare is tight: only one enrolled doctor per 1,006 patients accepts Medicare, according to the Kaiser Family Foundation.
It's a problem that Barbara Ann Cox of Tallahassee knows too well. When her family doctor left his practice last year, she found that many physicians and clinics would not accept new Medicare patients.

"I really had to shop around," says the semi-retired meeting planner. "I called eight doctors and clinics before I found one who would accept me, even though I'm in excellent health."

While several told Cox that they had 6-to-9-month waiting periods for Medicare patients, others refused flat out to take new clients whose primary source of payment would be Medicare. Another told her that he would file Medicare for her after she paid his fees up front and that Medicare could then reimburse her.

The most annoying, however, were those clinics who said they took new patients only to change their story once they learned that Cox relied on Medicare.

"I can understand if a doctor's dance card is full, but they should say that up front – not after the caller says she's on Medicare," said Cox. "I think that is discrimination against Medicare patients."

Cox eventually found a family doctor who accepts Medicare, but it took persistence.

The cost reductions are an issue because of a 1997 law that created a flawed formula for doctor reimbursements in Medicare called the "Sustainable Growth Rate" formula. The SGR formula would have gradually reduced payments to doctors, but Congress has repeatedly refused to allow it to go into effect.

The one-year "doc-fix" delay kept the SGR reimbursements from becoming a crisis as nearly 2.8 million Baby Boomers turn 65 in 2011. However, a permanent solution is required to ensure that Medicare will remain a viable program as the ranks of eligible seniors increase.

"Our work is not over," said Jeff Johnson, AARP Florida's interim state director. "AARP renews its call on Congress to make replacing this unstable payment system an urgent priority next year so we can ensure greater stability for the doctor-patient relationship in Medicare.”

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