The clock is ticking on fixing a flawed and unfair system that will limit the number of physicians who may provide essential care in the future. Medicare payments to Maine are scheduled to be cut by at least $12 million beginning in January. And, from 2006-2014 the cuts are scheduled to total $570 million. These cuts are coming at a precarious time for our nation’s health care. The baby boomer generation is reaching retirement age, and the number of seniors in America also is beginning a rapid rise.

The demand for physician services is growing. But the flawed Medicare reimbursement schedule is serving as a disincentive for physicians to include these patients in their practices, or for medical students to choose to go into internal medicine, family practice and other specialties that our seniors depend on for their care.

Doctors are paid for their services to Medicare patients using rates established by the federal Medicare Physician Fee Schedule. The fee schedule rates are determined using a mechanism called the sustainable growth rate, or SGR, formula.

Right now, a cut of 4.4 percent for each Medicare service is scheduled to go into effect this January, and future cuts are projected to decrease physicians’ reimbursements by more than 26 percent over the next six years.

The formula unfairly ties the Medicare payments to an arbitrary budget target that does not take into account patient needs. As a result, Medicare payments for physician services keep decreasing while the cost for doctors to provide care keeps climbing.

Today, Maine has 226,696 Medicare patients being treated by 3,995 physicians. But 39 percent of today’s physicians in the state are over the age of 55, and approaching retirement. Future doctors must be encouraged to provide care for the growing number of patients. Nationally and within our own state, the number of physicians going into internal medicine and family practice has declined precipitously. Although many factors affect specialty choice, medical students are “voting with their feet” by rejecting the specialties that take care of the most Medicare patients.

Clearly, as the number of Medicare enrollees increases, so will their demand for physicians’ services. Baby boomers, and others, likely will face a decline in the number of doctors willing to accept new Medicare patients. Due to increased numbers of patients going to doctors who do accept Medicare patients, waiting times for appointments are sure to be longer.

The pressures of retiring doctors, the growing numbers of Medicare-eligible patients, fewer young physicians going into internal medicine and family practice and the declining willingness of physician practices to accept Medicare patients are certain to increase the need for more primary care doctors to take care of Medicare patients. Yet the federal government is driving them out by cutting payments.

On top of the strain these additional patients will place on the program, the federal government is beginning several initiatives to improve the quality of health care. These initiatives call for increased reporting of how physicians perform based on measures of good patient care, thereby increasing the time-pressure on physicians. The initiatives also increase physician expenditures through the need to invest in health information technology, such as electronic health records.

Several recently published studies call attention to the need for improvement in the quality of health care. The New England Journal of Medicine published a study that showed that patients were only receiving about 55 percent of recommended care for various conditions and treatments. From this statistic alone it is easy to see why improvements need to be made. Payment cuts undermine the ability of physicians to invest the time and resources required to improve health care quality.

The projected Medicare cuts may keep internists from participating in quality improvement programs because we will not be able to afford the electronic health records systems that are needed to participate in such programs. A new study found that widespread adoption and effective use of electronic health record systems (EHRs) and other health information technology (HIT) improvements could save the U.S. health system as much as $162 billion annually by greatly improving the way medical care is managed, greatly reducing preventable medical errors, lowering death rates from chronic disease, and reducing employee sick days.

But the same study found that electronic health records cost on average $33,000 per physician with monthly maintenance cost of $1,500 per physician.

Few doctors will be able to afford the cost if the federal government goes ahead with reducing Medicare reimbursement by tens of thousands of dollars.

The elderly and disabled patients of Maine expect Congress to do what is necessary to improve health care access and quality. Congress must fix the flawed and unfair Medicare payment system before it is too late.

Ted L. Sussman, MD, FACP is a physician in Houlton, and the governor of the Maine Chapter of the American College of Physicians.