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Area physicians decry threatened drop in Medicare reimbursements

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Dr. Shirin Morad says she will have to consider closing her practice in Hardeeville if Congress doesn't intervene to prevent a 10.6 percent

reduction in Medicare reimbursement rates.

Morad, like other doctors whose patients are mostly elderly, would be hard hit by the rate reduction. About 65 percent of her patients are insured through the federally funded program.

"With a high Medicare population, it really puts us out of business," Morad said. "I've had to find another way to bring an income. I said I would never do it, but it's impossible with (reduced) insurance (reimbursements)."

The lower rates doctors receive for caring for Medicare patients officially went into effect Tuesday,but won't actually have an impact until July 10. Medicare administrators are holding off on processing claims until then in the hope that Congress will act after reconvening Monday.

Reimbursement payments are based on a complex formula that factors in a number of variables -- where a patient lives, the type of Medicare coverage he or she has and the national economy.

In 2002, reimbursement rates were cut 5.4 percent. More cuts have been proposed in subsequent years, but Congress has always intervened, allowing either small increases or eliminating the cuts.

Doctors and medical associations say the formula is based on an antiquated system in need of reform. Since a complete overhaul is unlikely this year, these groups hope Congress will enact another quick fix to prevent a cut in reimbursements.

While they wait, many doctors are finding other ways to keep their practices profitable.

"I've had to make so many changes," Morad said. "Medicare isn't keeping our doors open."

Morad, for instance, hired a nurse practitioner to work in her office while she works a second job as the hospitalist at Coastal Carolina Hospital in Hardeeville. A hospitalist is usually an internal medicine physician who treats patients in need of primary care. The income from that job allows her to keep her practice open, but if Medicare reimbursements are cut, she'll be in a bind.

A 2007 Medicare report predicts total cuts in reimbursements of about 40 percent by 2016. By the same time, practice costs are expected to increase 20 percent.

In addition to the 10.6 percent cut currently proposed, reimbursements are expected to be reduced by another

5.4 percent in January.

That could force other doctors to close their practices or stop accepting new Medicare patients, said Dr. James King, president of the American Academy of Family Physicians.

Practically speaking, that means patients 65 or older or who are disabled would have to look harder for doctors willing to treat them.

Dr. Michael Gilbreath of Hilton Head Gastroenterology said many local doctors are making tough choices.

Gilbreath moved his office to a smaller, older building to reduce his rent. Some of his colleagues haven't offered raises to their staffs. Others have refused to accept news Medicare patients.

A typical doctor's visit on Hilton Head Island costs about $180 an hour, Gilbreath said. The average Medicare reimbursement is about $40, he said.

"People wonder why they only see their doctor for 10 minutes," Gilbreath said. The reason: Doctors can make up for low Medicare reimbursements by seeing more patients for shorter amounts of time.

In South Carolina, reimbursement rates are among the lowest in the country, Gilbreath said. While it's relatively inexpensive to live in the Palmetto State, the cost of living on Hilton Head is nearly double the national average, he said.

Though many doctors are faced with losing money on Medicare patients, some say it's impractical to turn them away.

"That would be like shooting ourselves in the foot because that is a majority of our patients," said Dr. Bob Soares of Hilton Head General and Laproscopic Surgery and chief of staff at Hilton Head Hospital. "It's more feasible for an internal medicine doc to do that if they have ancillary services they can make money off of."

"We'll keep going until we can't," he said. "It's not our intention to drop our Medicare patients, but at some point, we will get to the point of no return."

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