WASHINGTON — Breast cancer surgeon Kathryn Wagner has posted a warning in her waiting room about a different sort of risk to patients' health: She'll stop taking new Medicare cases if Congress allows looming cuts in doctors' pay to go through.
The scheduled cuts — the result of a failed system set up years ago to control costs — have raised alarms that real damage to Medicare could result if the lame-duck Congress winds up in a partisan standoff and fails to act by Dec. 1. That's when an initial 23 percent reduction would hit.
Neither Democrats nor newly empowered Republicans want the cuts, but there's no consensus on how to stave them off. The debate over high deficits complicates matters, because every penny going to doctors will probably have to come from cuts elsewhere. A reprieve of a few months may be the likeliest outcome. That may not reassure doctors.
"My frustration level is at a 9 or 10 right now," said Wagner, who practices in San Antonio, Texas. "I am exceptionally exhausted with these annual and biannual threats to cut my reimbursement by drastic amounts. As a business person, I can't budget at all because I have no idea how much money is going to come in. Medicine is a business. Private practice is a business."
Former Medicare administrator Gail Wilensky, a leading Republican policy expert, says lawmakers coming back to Washington next week better take note. "We simply cannot let physicians take a 23 percent reduction in payment and think that we are not going to seriously disrupt access for beneficiaries," Wilensky said.
Yet there's no agreement among lawmakers and the Obama administration on how long a reprieve to grant or whether the cost — about $1 billion per month — should be added to the deficit or paid for with spending reductions elsewhere.
There's widespread recognition that the way Medicare pays doctors is flawed because it rewards sheer volume of services, not quality results. But there's no agreement on a better way.
So, in the 1990s, lawmakers devised a formula for cuts as an automatic braking system to keep Medicare humming along at a sustainable growth rate.
Except every time costs went up, Congress hit the override button.
Repealing the formula now would cost more than $280 billion over 10 years.
The American Medical Association is calling for a 13-month reprieve that would give Congress time to work on a new payment system; the administration supports that approach.
"The single biggest step we can take to strengthen Medicare ... is to make sure these disruptive cuts don't take effect," said Health and Human Services Secretary Kathleen Sebelius.
"We will ultimately need a permanent fix ... but in the meantime, we don't want any doctor to be stuck in a limbo where they don't know week to week how much they'll be paid."