June 1, 2010 -- A missed deadline by Congress may mean many of the country's 44 million Medicare patients will have a harder time finding a doctor -- piquing the frustration of many physicians who already care for these patients.

On Friday, the Senate adjourned for its traditional Memorial Day break without eliminating a physician payment cut for treatments to Medicare patients that took effect today, which means that the country's doctors may soon be paid 21.3 percent less to treat Medicare patients.

In a statement issued Friday, Dr. James Rohack, president of the American Medical Association, expressed outrage.

"The Senate has turned its back on seniors," Rohack said in the statement. "Senators are more interested in heading home for the holiday than in preventing a Medicare meltdown for seniors... Already, about one in four Medicare patients looking for a new primary care physician have trouble finding one, and Congressional inaction will make it much worse."

There are signs the Medicare payment will be kicked down the road when the Senate returns on June 7. On Friday, the House of Representatives voted 245-171 to pass H.R. 4213, which among other things would freeze the payment cuts until December 2011 -- though the move came too late for the Senate to act to pass the legislation. If the payment cuts are delayed, it will not be the first time; Congress has instituted such delays nine times over the past eight years, most recently last April.

Meanwhile, the Centers for Medicare and Medicaid told doctors groups in a letter on Thursday that it will hold claims for 10 days after June 1 to allow the Senate to pass the bill. But for now, doctors were split on how their already struggling practices will deal with the cuts, should they turn out to be longer lasting.

"I honestly do not know what our practice will do," said Dr. Scott Fields, professor and vice chair of the Department of Family Medicine at Oregon Health and Science University in Portland. "What I can say is that the easiest thing to do would be to immediately close to new Medicare patients. This would maintain our commitment to established patients, but limit our risk."

Physicians Pledge Continued Treatment for Medicare Patients

Other doctors said they would continue to accept new these patients.

"We will continue to treat Medicare patients and will accept new ones despite the chronic reimbursement problem," said Dr. John Sutherland, program director emeritus of the Northeast Iowa Medical Education Foundation.

For some, sustaining care for these patients has become a moral imperative. Dr. Richard Colgan, a family medicine physician at the University of Maryland Medical Center in Baltimore, said his practice will continue seeing Medicare patients "because it is the right thing to do and we are professionals. True healers take care of people, irrespective of the fee payment schedule."

"We won't change how we treat Medicare patients of course, because we're mission-bound to treat everyone equally," said Dr. Lee Green of the University of Michigan's Department of Family Medicine. But, he added, "This will be an absolute fiasco for primary care physicians nationally... I can't imagine a more destructive thing for Congress to do in the current state of our health care system. To be blunt, I consider this a management failure on the part of Congress, irresponsible bordering on reckless."

Deficit Spending Concerns May Be Holding Cuts in Place

Part of some lawmakers' ambivalence to support delaying the cuts could be concern over deficit spending. The Congressional Budget Office estimates that over the next two years, such a fix would tack an additional $22 billion to the federal deficit.

The cuts in reimbursement actually stem from a formula based on the sustainable growth rate, or SGR, a program Congress set up in the 1990s that tied the payments doctors received for treating these patients to the GDP. But even though the cuts were scheduled to take effect at the turn of the millennium, a series of quick fixes have pushed the schedule back.

In the meantime, under the threat of such cuts, physicians have been forced to balance their duty to serve patients against the pressure not to be the last center available to Medicare patients. In this game of musical chairs, the last practice standing could get walloped with a flood of low-revenue Medicare patients -- a hit that Fields said could risk destroying a practice.

Medicare Reimbursement Cuts Could Hurt Practices

Some doctors anticipate that this threat will force them to change the way they conduct their practices -- and for some, the changes have already begun.

"I have not taken new Medicare patients for two years in anticipation of this very event," said Dr. Marsha McKay, a family physician in Twain Harte, Calif. "If it becomes a permanent 21 percent cut, I will change to no longer taking assignment for Medicare and will be able to balance bill my patients for their visit. If I don't, I will be paying about $23 to see them each time."

Dr. Neil Brooks, a geriatrician who works at a nursing home and rehabilitation center in Vernon, Conn., said doctors like him who treat older patients will be particularly affected.

"In the short term I will continue to see Medicare patients, but if the cut is instituted and maintained I would most likely be forced to discontinue my current practice," Brooks said. "That would sadden me because I enjoy what I do and believe that I do it well. I would suspect that it would also sadden the many patients for whom I care."

Dr. Randy Wexler, assistant professor of Clinical Family Medicine at Ohio State University, said that he has begun accepting Medicare patients who come from one to two counties away due to the fact that many family physicians have closed down altogether -- not just to Medicare patients.

And he said that doctors' patience is running out.

"This on-again, off-again, 10-day, two-week, two-month or whatever delay is very much hurting the ability of physicians to run a practice," Wexler said. "This is no longer a Republican or Democrat issue. Congress and the White House have finally generated bipartisanship. Physicians are equally angry at both parties."