Mass. Doctors Weary Of Medicare 'Meltdown'

By Toni Waterman

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Jan. 6, 2011


WELLESLEY HILLS, Mass. — In a backstreet office park in Wellesley Hills, Dr. Richard Dupee ushers Phil and Judie Fasano down a long blue hallway to an exam room at the far end of his office. For 26 years, the Fasano have been making the 20-mile trek from Braintree to Wellesley to see Dr. Dupee.
 
“People say to me, ‘why do you go all this way to see a doctor?’” says 72-year-old Phil. “Well, I think it speaks for itself. We go to him because he treats us well.”
 
And, more importantly, Dr. Dupee accepts Medicare patients -- at least for now.
 
“My fear is losing him as my doctor,” says 71-year-old Judie, whose laundry list of medical problems includes kidney disease and diabetes.
 
The Fasanos, like millions of seniors across the county, may have to start looking for a new doctor unless Medicare reimbursements soon change. Low reimbursement rates have already prompted some doctors to opt out of Medicare, and many more would be expected to if Congress doesn’t shore up the system with additional money.
 
In Massachusetts, rising business costs are compounding the problem. Dr. Alice Coombs, president of the Massachusetts Medical Society, says that over the past 10 years, the cost of doing businesses in Massachusetts has increased by 35 percent, while Medicare reimbursements have gone up 1 percent. 
 
“It’s creating an environment that’s not conducive for physicians to survive in terms of practicing medicine with predominant Medicare patients. Doctors want to take care of all patients,” Coombs said. “However, it becomes increasingly difficult for them to have an operational budget to be able to do that.”
 
That means the one million seniors who already rely on Medicare in Massachusetts aren’t as secure with their health care providers as they would like to be. With the first of the baby boomers hitting the age of 65 this month, that number is only growing.
 
An Unbalanced Budget
 
When Medicare was signed into law in 1965, it was designed as a medical safety net for the elderly. But as the years have passed, spending has quickly outpaced budget. Right now, it would take $600 billion just to balance the Medicare budget.
 
While the program has been riddled with financial headaches from the beginning, the latest round of problems stem back to 1997, when, in an effort to control spending, Congress came up with a complex formula to reign in ballooning Medicare costs. Basically, Congress capped yearly expenses, so if the costs for a given year went over the limit, the excess would be deducted from the following year’s budget. 
 
“You can’t go about that ceiling, whatever that figure was. And if you go above that ceiling, the only way to stay below that ceiling of cost is to reduce either services or fees,” Dr. Dupee said.
 
At first, it worked. Medicare costs were kept below the yearly limit, so neither services nor doctor reimbursements were cut. But by 2002, the ceiling had been shattered – expensive tests like MRIs became popular, new treatments for diseases like cancer meant people were living longer and the number of people on Medicare skyrocketed.
 
The solution? Cut the amount of money paid to doctors – a solution that Dr. Dupee says has been looming for a decade.
 
The Medicare Deficit Comes Home
 
“We heard about a 9 percent reduction in fees as of January 1, 2010. Then this summer we’re hearing it will be a 25 percent reduction as of December 1, 2010 to try and catch up for all the years Congress kicked the can down the road.”
 
But Congress is still kicking. In December, the rollback was delayed another year, with President Barack Obama signing the ‘doc-fix’ into law in the 11th hour.  Many, including Dr. Dupee, say a 25 percent cut in pay to doctors would become a national disaster.
 
“Many physicians would stop seeing Medicare patients, not accept new Medicare patients, some would completely withdraw from Medicare completely,” Dupee said.
 
No one has a solution at this point, but Dr. Coombs says one part of the fix is prevention.
 
“If we look at things like ER visits and preventable hospitalizations, they contribute to close to a billion dollars in the state.”
 
Meanwhile, the Fasanos are left in limbo, not knowing where they’d turn if Dr. Dupee closes up shop.
 
“Whatever Dr. Dupee gets paid, I think he’s well worth it,” says Judie.
 
Right now, Phil says their only hope is that a solution is found in the next year.
 
“Someone’s got to pay for this and it can’t be all the seniors. We’re the ones who are sick. We’re the ones who are aged. We’re the ones who need the most help.”
 
But at this point, the Fasanos are in better health than their health care.
 



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