AMA President Peter W. Carmel, M.D. Issues a Message to all Physicians Regarding Medicare Turning Retirees into New “Medical Tourists” amednews.com — AMA Leader Commentary: A few words about current events in medical practice  

I suspect in the minds of many patients, there is a disconnect between the turmoil in Washington and the relationships they have with their physicians. They don’t quite understand the connection between Medicare payment and Medicare physician availability for themselves. For, other people, yes, but for themselves, no. Most people don’t make the connection among cuts in Medicare physician payments, the rising cost of medical care and their own welfare. They think that Medicare will be there for them when the time comes, or as it has been since they turned 65. And for many, that will be true. But depending on what happens during the deliberations of the Joint Select Committee on Deficit Reduction,  beginning in September, it may not be the case for many others. Year after year, increases in physician practice costs have exceeded Medicare payment updates. Even using the government’s own index of practice cost inflation, average Medicare payments since 2001 have fallen about 20 percent behind. By 2020, with the Medicare physician payment cuts forecast by the Medicare trustees, payment rates will be just half what they were in 2001. When Medicare payments no longer keep pace with the cost of care, physicians are forced to make one of two choices — either limit their Medicare patients or opt out of the program completely. Either way, patients and physicians both suffer. Welcoming Medicare patients has always been a good way for newly minted physicians to develop their practices, but that is becoming more difficult as the gap widens between payments and the cost of actually treating a patient. Similarly, in many rural areas and inner-city neighborhoods, where Medicare patients are a large part of the local population, physicians cannot earn enough from treating non-Medicare patients to cover the deficits they face from treating Medicare patients. Physician shortages already exist in many rural and inner-city neighborhoods. Another drop in Medicare payments will further hinder any effort to keep physicians in those areas — and any effort for the local residents to find doctors. Deciding whether or not to keep seeing Medicare patients can be agonizing for physicians. The thought of turning any patient away is an anathema to most physicians. In fact, many physicians facing that painful decision acquiesce in the end and decide they will go ahead and keep existing Medicare patients — but accept no new ones. Lately, I have become aware of a growing phenomenon in New Jersey, where I practice. I think of it as reverse medical tourism. Just as many parents are seeing their college-graduate students move back home, my colleagues have heard from a great number of patients who have retired and moved away — and want to come back to their original doctors for treatment. To continue reading, click here.