An Obama administration plan to cut Medicare payments to heart and cancer doctors by $1.4 billion next year is generating a fight from concerned specialists.
While President Barack Obama and members of Congress have spent August debating health insurance and medical costs at public forums, specialists are waging what one advocate calls a “tooth and nail” fight against a separate initiative to boost the pay of family doctors and cut fees for cardiologists and oncologists.
The specialists, in newspaper columns and meetings with lawmakers, say patients will lose access to life-saving care such as pacemakers and chemotherapy.
The proposal by Medicare, the government insurer for the elderly and disabled, is an effort by Obama to focus U.S. medicine on preventive care. The fight by physicians who work with the most expensive patients is weakening support for Obama’s broader goal, legislation to remake the health system, said Mark B. McClellan, 46, a former Medicare chief.
“If you can make the health care debate all about moving slices of the pie around, it’s very easy to generate opposition and very easy to get derailed,” said McClellan, a physician and analyst at the Brookings Institution, a policy research center in Washington.
Obama and his allies in Congress are pushing to extend coverage to Americans without health insurance at a potential cost of $1 trillion over a decade. The separate Medicare proposal, announced July 1, slashes projected spending for care by cardiologists and oncologists by more than 10 percent each while paying family doctors 8 percent more and nurses an additional 7 percent.
Patients could lose access
“Our 37,000 members are fighting tooth and nail on these other issues rather than fighting thoughtfully for expanding access,” said Jack Lewin, 63, chief executive of the Washington-based American College of Cardiology.
Specialists may decide to pull out of Medicare, or ask patients to make up the difference with higher out-of- pocket payments, said Alfred Bove, president of the American College of Cardiology.
“A fair number of cardiologists are looking at the accounting and saying, ‘We can’t afford it,’ ” Bove said in a telephone interview.
Some oncologists in rural areas may stop offering chemotherapy in the office, forcing patients to travel to more-distant hospitals, said Allen S. Lichter, 63, CEO of the 27,000-member American Society of Clinical Oncology in Alexandria, Va.
The cuts would be “impossible” for small-town cardiologists who rely on Medicare patients, said Zia Roshandel, a heart doctor in Culpeper, Va.
Roshandel and two partners see perhaps 50 patients. Medicare accounts for two-thirds of their clientele, he said. Already squeezed by government and private insurers, Roshandel said he has cut office hours, forgone paychecks and shifted his 12 workers to a high-deductible insurance plan over the past two years.
“I’m going to close”
If the proposal stands, “the bottom line is I’m going to close the office,” he said. “This is impossible for me to survive.”
Medicare would reduce reimbursements for some of Roshandel’s most common procedures, raising the amount patients will need to pay up front, he said.
The government would cut the $251 it pays for an echocardiogram, a sonogram of the heart, by 40 percent, he said. The rate for a cardiac catheterization, another test, would drop by a third to $249.
The Obama administration’s plan to raise payment for primary-care doctors is intended to encourage more doctors to enter the field.
Some 65 million people already live in areas considered by the U.S. Health and Human Services Department to have too few primary-care doctors, with less than one practitioner for every 2,000 people, according to department figures as of March 31.
