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Michael Michaud

Maine doctors deserve a permanent fix to Medicare payments
By Representative Mike Michaud
Dec 11, 2010 - 12:13:54 AM

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We need to fix how doctors are reimbursed through programs like Medicare. If we don't, we stand a good chance of decreasing access to health care for our nation's seniors and military families.

Under Medicare, beneficiaries obtain health care services through providers of their choice and Medicare makes payments to doctors for the services that are provided. These payments are made according to something called the Sustainable Growth Rate (SGR), which is a formula that makes annual adjustments to the physician fee schedule to determine how much a physician is paid for the services they provide.

Unfortunately, under current law, the SGR calls for cuts in the repayments that doctors receive each year. As a result, Congress finds itself in the position of needing to pass annual patches to prevent these cuts. And it's important Congress acts because rural areas like Maine are particularly hard hit, given the already low reimbursement rates set for our state's doctors.

To remedy the problem, the House passed a bill last year that would replace the SGR with a new formula that would make sure our doctors receive adequate payments. This would allow our providers to keep their doors open and continue to see patients. In addition to helping our seniors, this bill would also be beneficial to military families because payment rates for doctors in TRICARE, which is the military's health care program, are tied to Medicare rates. But to my disappointment, the bill never passed the Senate.

As a result, earlier this year I joined with my colleagues to urge congressional leaders to keep working on a bill so that we can finally fix the Medicare payment problem for good. I joined this effort because it is an important priority for our state. We have an extremely high rate of seniors that rely on Medicare for their health care, and they are justifiably fearful that their physicians may leave the state if they can't afford to stay in business due to inadequate reimbursement rates.

Fixing the payment formula will ensure that physicians can continue to deliver high quality health care, especially in rural areas like Maine. But this even this formula isn't perfect for many reasons, including the fact that current calculations result in low reimbursements for Maine when compared with our neighboring states. This is unfair and it's why I've been pushing for a change that would provide our state's doctors with reimbursements similar to those in the Boston area. Ensuring that our state's doctors are paid fairly for the services they provide is critical to ensuring all of our seniors get the access to care they need.

Unfortunately, these critical issues were not addressed. Because of this, Congress needed to once again pass a short term fix like they have done many times in the past.

On December 9th, the House cleared a bill that as I write this is on its way to the President for his signature into law. The bill will make sure that, for one more year, seniors and military families will be able to continue seeing their doctors. Specifically, the bill blocks the SGR's scheduled 25 percent cut in Medicare payments, which will help prevent doctors from leaving rural areas of Maine and help keep the doors of our many clinics open.

It might be a fix for now, but it does not address the underlying problem of the flawed SGR. A permanent fix is definitely needed.

Representative Mike Michaud

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