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Neurologist says more health care fixes are needed

Health care reform may change the way Americans receive medical care and how the costs of that care are paid, but the changes in the nation’s health care system do not address some key problems, a local neurologist said.

Dr. Lori Guyton, a Herrin-based neurologist, said that Congress’ failure to permanently fix the way doctors are reimbursed by the federal government and the way that specialists are reimbursed will ultimately lead to a shortage of physicians.

Guyton said that all physicians who treat patients through Medicare are subject to reimbursement payments that do not reflect today’s costs and the payments do not cover physician’s expenses of running their practices.

“This is not even part of the Health Care Reform bill,” Guyton said. “The payments are tied to what’s called the Sustainable Growth Rate formula. SGR measures how much Medicare can grow without borrowing more money. After Medicare passes this rate, it must reduce reimbursement to facilitate growth. Therefore, when the government spends more on Medicare than is budgeted, the government threatens to reduce the payments to doctors.”

She said that each year, Congress has to act with a stop-gap measure to prevent the cuts in reimbursement.

“Last year Congress threatened to reduce payments to physicians in January, then it got pushed back to April, before they subsequently voted not to implement it,” she explained. “The problem is every time they delay, ‘the fix’, the current deficit in Medicare increases”.

As of April 1, the Senate did not delay the anticipated cut and the 21 percent Medicare reduction to physician payments went into effect, becoming law. In 2011 an additional 24 percent cut is anticipated.

Dr. J. James Rohack, who serves as president of the American Medical Association said Congress needs to act now.

“It’s time for all of our representatives and senators to do what is right to protect access to care for seniors and military families, and to assure the viability of physician practices with reimbursements that meet the costs of keeping an office open,” he said.

Guyton agreed. That is why she recently traveled to Washington, D.C. with colleagues for the American Academy of Neurology’s “Neurology on the Hill”. In Washington, the neurologists visited legislator’s offices and urged them to find a long-term solution. Physician incentives were also discussed, and amendments to the H.R. 3200.

“We told them we’d like a permanent fix instead of temporary patches, and soon,” Guyton said. “We’re concerned with the reduction that’s looming in the future and the access to care for patients.”

All total, more than 100 neurologists met with legislators as part of the annual program. The academy called the program one of the most effective ways of sharing physician and patient concerns with elected officials. This year’s representatives, including Guyton, urged lawmakers to make permanent revisions to the reimbursement program.

Guyton said that the problem with Medicare reimbursements could affect the quality of care patients receive, the timing of health care and ultimately the quality of life in southern Illinois.

She explained that with a troublesome reimbursement program, many physicians and specialists may leave practice, retire early or decide to stop seeing patients who rely on Medicare.

“If that happens, I’m concerned with what it will do to patient care. If there are fewer physicians, patients may not be able to get the care they need,” she said. “If more citizens are provided healthcare, the que for services may reach extraordinary waiting periods to be seen.”

Guyton said that there are only four practicing neurologists in southern Illinois, and often the wait time for an appointment can be several months.

It’s a problem that she doesn’t expect will get much better for patients.

“Access to care is a huge issue,” she said. “Today neurology spots are not being filled in medical schools; there are very few students entering the specialty.”

According to the American Academy of Neurology, many reimbursements are based upon procedures performed by physicians, not ongoing principal care services such consulting with patients and ongoing care for chronic conditions. As such, procedure-driven specialties are better-reimbursed and in the past have attracted more medical students. That may change as bonus incentives for primary care physicians is anticipated to begin in 2011. However, such bonuses do not apply to specialists such as neurology. Guyton explained that efforts such as the “Neurology on the Hill” program express to members of Congress that specialists such as neurologists should be included in the bonus incentives.

“One in six Americans have some neurological problem such as migraines, seizures, Parkinsons’s Disease or Alzheimer’s, and we remain the primary provider for many of these neurologic conditions”, she added.

She said that is why she’s working with other neurologists to encourage lawmakers to fix Medicare and provide incentives for physicians to go into neurology and other specialties as well as primary care.

“The bottom line is access to care for patients,” she said.

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