RAPID CITY - Proposed cuts in Medicare reimbursements for doctors could make it more difficult in the future for patients to get treated under Medicare in South Dakota cities. In more rural areas, the cuts would make it more difficult to recruit doctors.

That's the worrisome scenario envisioned by the South Dakota State Medical Association, according to its president, Dr. Tony Berg of Winner. The state association, representing more than 1,600 medical doctors and doctors of osteopathy, contends that South Dakota will bear a greater burden than many other states if the Medicare cuts become reality - not only next year, but over the next nine years.

Berg planned to speak about the Medicare cuts at a meeting of the Black Hills Medical Society on Tuesday night in Rapid City.

The state medical association is lobbying Congress to stop the Medicare program from making the cuts. The House has passed a bill to block the cuts, but the Senate has not yet acted, Berg said.

The cuts would hit South Dakota particularly hard, because it has an above-average proportion of Medicare patients - 15 percent - and, at 14 physicians per 1,000 beneficiaries, a below-average ratio of physicians to Medicare beneficiaries, according to the state medical association.

The 10 percent cut in Medicare reimbursements to doctors nationwide would cost South Dakota physicians $16 million next year. The cuts would cost South Dakota physicians $620 million by 2016 for the care of elderly and disabled patients, the association says.

In addition to the 10 percent cut next year and a 5 percent cut in 2009, Medicare would cut another 3.2 percent from doctors in South Dakota.

Berg explained that a geographic adjustment is an additional penalty on doctors in rural states. He said the adjustment wrongly assumes that care costs more in urban states such as New York.

Although rents are cheaper in South Dakota, physicians still must buy expensive equipment and must hire staff, he said.

Berg said physicians in bigger cities such as Rapid City and Sioux Falls may opt to take fewer Medicare patients if the cuts go through. "If you're an orthopedic surgeon in Rapid City, and you're busier than you want, if you have a choice, you're going to take patients who can pay more than Medicare patients," he said. Such doctors can tell Medicare patients, "I'm busy," he said.

That's less possible in small towns, where there may be only one doctor, Berg said.

However, the cuts will make it more difficult to recruit physicians to replace the small-town doctors who are retiring, said Berg, who has practiced in Winner since 1981. "When I leave, the next guy is going to be harder to get."

Berg disputes critics who blame greedy doctors for escalating health-care costs. He said new technology and medicines are the primary reasons health-care costs are soaring. Inflation also affects doctors, just like the rest of the economy, he said.

Berg said the Medicare program continues to raise the pay for hospitals while it tries to cut pay for physicians every year.

The result, he said, is more doctors becoming employees of hospitals.

Berg says doctors who own their own medical practice have a greater stake in providing good patient care than a doctor who is an employee or, - worse in his view - a doctor who works for a state-run medical system.

Berg said the federal government has attempted for five or six years to cut Medicare reimbursements. "Every year, we've gone to Congress and gotten them to stop the cuts at the last minute," he said. "Right now, we're at the last minute again."

Berg said both Sens. Tim Johnson, D-S.D., and John Thune, R-S.D., want to keep the reimbursement rate the same this year. They, along with Rep. Stephanie Herseth Sandlin, also favor revamping the system longterm.

Congress, as a whole, he said just hasn't been able to fix the overall reimbursement formula. "Every year, they just put a cork in it," Berg said.

South Dakota Medicare facts * S.D. physicians would lose $40 million for care of Medicare patients over the next two years due to a 10 percent cut in 2008 and another 5 percent cut in 2009.

* South Dakota has 117,424 Medicare patients and 28,507 TRICARE (military retirees and their families) patients who could be affected by Medicare cuts.

* There are 9,140 employees in South Dakota who could be affected.

Source: S.D. State Medical Association

Contact Steve Miller at 394-8417 or steve.miller@rapidcityjournal.com