Medicare fee debate frustrates physicians

Washington, DC-As Congress continues to debate health-care reform and how best to pay physicians for providing medical care to the nation's neediest and elderly people, ophthalmologists are increasingly frustrated by the instability it wreaks upon their practices.

As the medical specialty with the greatest dependence upon Medicare because of the age-related nature of many eye conditions, ophthalmology is uniquely challenged by the ups and downs of the Medicare fee debate, ahead of cardiology and general internal medicine, said William L. Rich III, MD, the American Academy of Ophthalmology's (AAO) medical director of health policy.

Many ophthalmologists watched closely as the March 1 deadline passed that was to signal the beginning of a 21.2% reduction in fees paid by Medicare, and the 30-day reprieve gained and signed into law on March 2 offered little comfort.

"We are in a position where we are not getting cut, but it was very disruptive. Doctors are very frustrated," said Cathy G. Cohen, the AAO's vice president of government affairs. "This is no way to run a program."

Most physicians operate small, private practices that are rightfully considered small businesses, she said. A prospective 21.2% cut in fees was prompting many of them to consider laying off staff, taking early retirement, or changing their participation status as a Medicare provider.