Medical Economics

Information for Medicare/Tricare patients

Source: American Academy of Orthopaedic Surgeons Research and Health Policy Departments, 2007.

MEDICARE AND MALPRACTICE REFORM ALERT, April 2010

Dear Patient,

MEDICARE:

Health Care Reform has been in the news lately. What you may not have heard is that Medicare reimbursements to doctors are scheduled to be cut on May 31, 2010 by 22%. Despite passage of President Obama’s recent health care reform, these cuts are still scheduled to go into effect on June 1. These cuts come up every few months or so, and Congress just kicks the can down the road a bit, but now we are potentially facing them again with no permanent solution in sight.

You might be wondering: “How could this affect me?”

The chances are very high that you fit into one of two categories: either you have Medicare (or Tricare for military families), or you know someone who has Medicare, like an older relative.

Here's the bottom line: If these changes go through, access to medical care will be severely restricted. Given the rising costs associated with running a medical practice, if these cuts go through, we will have to, as will many other doctors, stop taking new Medicare or Tricare patients.

MALPRACTICE REFORM:

Another issue that will affect Georgia patients is Malpractice Reform, also called Tort Reform.

In 2005, Georgia enacted malpractice reform which allowed costs of malpractice insurance to be more in line with costs in other states that have enacted similar reforms. As a result, more doctors have chosen to practice in Georgia, which is an issue especially here in the southwest part of the state.

For physicians, the risk of a malpractice lawsuit is not evenly spread across all specialties, but is especially high for fields such as orthopedics and spine surgery, and approximately 1/3 of all orthopedic surgeons can expect to be sued in a given year. High litigation rates jeopardize our ability to provide affordable health care, and overuse of expensive tests as part of defensive medicine is a result.

Georgia has had malpractice reform in place until the week of March 22, 2010, when the Georgia Supreme Court struck down these reforms.

Here is how the court decision may affect you:

-The cost of delivering care to patients, which includes malpractice insurance, will rise, and these costs will have to be passed on to the consumers like you and your family.

-More charges will be generated as defensive medicine will be practiced more intensively.

-For those patients who have fixed reimbursements, like those on medicare and medicaid, the number of openings for patients with those types of insurance will have to be significantly limited.

-Newly trained physicians will be less likely to choose to practice in Georgia and older physicians may choose to retire sooner. Access to care will become a problem.

The physicians of Orthopaedic Associates agree that victims of medical malpractice deserve compensation, but lack of reasonable caps incentivizes lawyers to sue doctors for staggering sums under the guise of malpractice claims, regardless of whether the patients gave informed consent and received responsible, quality care.

We are not sure what the next step will be, but hope that some legislative fix can be applied so that patients don't lose access to the medical care they so deserve.

We urge you, in the meantime, to contact your state representative to express your feelings on this issue.

In order to prevent these threats to access to medical care from becoming a reality, we need your help. We need you to contact your congressmen and state representatives right away to express your opinions on this matter.

Please call Congress today for Medicare issues and the State Legislature for Malpractice Reform issues to share your thoughts in this regard. Don't ignore this issue thinking that somebody else will take care of it. Don't wait until you or your older family member can't find medical care. Please call today.

Sincerely,

The Physicians of Orthopaedic Associates.

Congressional Contact Phone Numbers for Medicare Reimbursement Issues:

Congressman Sanford Bishop, Albany Office (229) 439-8067, Washington DC Office (202) 225-3631

Senator Saxby Chambliss, Toll Free 800-234-4208, Washington DC Office (202) 224-3521

Senator Johnny Isakson, Atlanta Office (770) 661-0999, Washington DC Office (202) 224-3643

State Contact Phone Numbers for Malpractice Reform Issues:

Governor Sonny Perdue, Office of the Governor, Georgia State Capitol, Atlanta, GA 30334, Phone: 404-656-1776

Lieutenant Governor Casey Cagle, 240 State Capitol, Atlanta, GA 30334, Phone: 404-656-5030

Representative Winfred J. Dukes, 411-D Coverdell Legislative Office Building, Atlanta, GA 30334, Phone: 404-656-0127 or 920 Highland Avenue, Albany, GA 31701, Phone: 229-432-9891

Representative Bob Hanner, 512-A Coverdell Legislative Office Building, Atlanta, GA 30334, Phone: 404-656-7859 or 9610 Plains Highway, Parrott, GA 39877, Phone: 229-623-2841

Representative Ed Rynders, 401 State Capitol, Atlanta, GA 30334, Phone: 404-656-7855 or 423 Martindale Drive, Albany, GA 31721, Phone: 229-888-9928 (Office), 229-436-7455 (Home)

Senator John Dickey Crosby 324-A Coverdell Legislative Office Building, Atlanta, GA 30334, Phone: 404-463-5258 or Post Office Box 891, Tifton, GA 31793, Phone: 229-326-6780 (Cell)

Senator Freddie Powell Sims, 305 A Coverdell Legislative Office Building, Atlanta, GA 30334, Phone: 404-463-5259 or, 5377 Goose Hollow Road, Dawson, GA 31742, Phone: 229-347-0251

Additional information:

Medicare payments are currently regulated by a Sustainable Growth Rate (SGR) conversion factor, which is complicated to explain, but needs to be changed. This formula, which inappropriately ties total payments to physicians to the gross domestic product of our country, makes changes in reimbursement that have no relationship to the needs of the patients being served.

We need your help on this issue.

Unless a change is made to this SGR and permanent funding for Medicare is passed, we will face this issue every year as these cuts, which are passed on to future legislative sessions, are averted permanently.

To keep it in perspective, keep in mind that we have discussed with

--our employees

--our landlord

--our malpractice carrier and

--the companies who sell us our supplies

about giving us a discount (like the 22% discount that has been postponed) if these Medicare changes go through. In fact, none of these people want a cut. Not surprisingly, they all want a raise.

So, as you can see, a cut in Medicare with increasing cost is going to potentially preclude our group from taking Medicare starting in June 2010 unless something is changed.

It is up to you to write and call your congressional representatives and senators because we guarantee we have done our best so far to see Medicare patients, but will no longer be able to do so if these cuts take place, plain and simple.

Sincerely,

Mark Wolgin, MD (and the doctors of Orthopaedic Associates)

You can contact your Federal Representatives and Senators toll free by using the AMA Grassroots Hotline at 1-800-833-6354 and entering your zip code and you will be connected to the appropriate office.

Or, the contact information is also listed above for patients in the area of our practice.

And, for the record, on a recent patient care issue, I was bothered by the way non-emergency transport services would leave a Medicaid patient from a nursing home in our office. Some providers would bring in an older patient on a stretcher, leave them on an exam table (which has no guardrails) and leave. The situation was absurd, since we have no way, aside from the stretcher which they just took away, of even getting that patient to Xray or the cast room.

I wrote a series of letters to the GA Dept. of Community Health, with carbon copies to the Governor, and finally got a response:

/Documents/Mark Trail letter0001.pdf

Mark A. Wolgin, MD Orthopaedic Surgeon

Specialist (Fellowship Trained) in Spinal and Foot/Ankle Surgery