The existing cuts have already taken a toll. On Jan. 1, the prestigious Mayo Clinic will stop participating in Medicare in its Jacksonville, Fla., location. Though its clinics in Minnesota and Arizona never accepted Medicare as full payment, the Florida clinic did, in part to cater to the local elderly population. But with more than half its patients on Medicare, the Jacksonville clinic believed it could no longer absorb the payment cuts. “For each patient, we were not getting enough to cover costs,” says Dr. Denis Cortese, who takes over as president and CEO of the Mayo Foundation next month. Like the other Mayo locations, Jacksonville will still see Medicare patients, but they’ll have to pay the clinic directly and get reimbursed from Medicare. For patients without secondary insurance, the out-of-pocket tab could rise 66 percent. “Some patients are worried they’re going to be hassled,” says Dr. Jack Leventhal, chair of the clinical-practice committee. But he expects few will abandon the clinic: focus groups suggest that most patients are willing to pay a bit more for Mayo’s topnotch health care.
Smaller practices may take even more drastic action. Drs. Abraham and Chaim Rogozinski stopped seeing Medicare patients altogether at their Jacksonville orthopedic-surgery practice. The brothers put up with Medicare’s regulatory hassles and low pay for years, but with soaring malpractice rates, last January’s payment cut pushed them over the edge. “This is probably the hardest decision we’ve made in our practice,” says Abraham. One patient even sent the docs’ mother a plea to get them to reconsider, saying she “sat and cried” when she learned they would no longer treat her. Other doctors in town quietly congratulated them on the gutsy move, the brothers say. “There’s a horrendous crisis going on,” says Chaim. “Until the system implodes, no one’s paying attention to us.” If Congress doesn’t act, that could soon change.
