Not the Same Auld Lang Syne
by Dr. Keith A. Bourgeois

What a year! Our Harris County Medical Society (HCMS) and Texas Medical Association (TMA) officers led us through some very productive and interesting times in medicine. I must give my due to the leadership of our own immediate past HCMS President, Guru N. Reddy, M.D., who kept us on course and to each of the HCMS officers who dedicated their some time and efforts to their patients and medicine.

Since the new year and my HCMS presidency are beginning off with all the familiar dilemma about Medicare fees, I want to mention how far we’ve come and how your help is needed now, more than previously. Take a good look with this graph before you read any more.

As the government, yet again, toys around with our Medicare patients that have worked all of their lives, fought for country, and so are physically and mentally disabled, we still care for these patients hoping that our Medicare fees will likely be worked out so that people can keep our practices afloat.

In a nutshell, the Sustainable Growth Rate (SGR) formula states if spending because of increased usage of Medicare services rises faster compared to nation’s gross domestic product (GDP), Medicare must compensate by cutting reimbursement rates for physicians enough to bring spending back in line with GDP growth. By the end of 2001 it became apparent that more advanced procedures and techniques to improve health care were increasing Medicare spending in a much faster rate than Congress had anticipated. This is when the initial serious cuts on the SGR were proposed, and that we began our fight to repeal the SGR formula.

Congress has been postponing the cuts each year since 2003. The first delay in 2003 cost $21 billion for any one-year delay along with the two-year delay in 2004 cost $38.6 billion. Presently, fully repealing the formula would add nearly $300 billion for the national deficit, according on the Congressional Budget Office. So, here we go again. Congress is discussing another two-year fix by doing the same thing they have done since 2003 – another short-term resolution that can only increase the costs accumulating every year. If this continues, by 2016 it'll cost you $600 billion to eliminate the SGR. The longer we put them back, the less likely a permanent fix becomes.

Every year since 2003, TMA and HCMS happen to be fighting, first of all to stop the proposed cuts but in addition to have Congress approve a lasting solution. While it may well not seem as it, we've actually made significant headway recently. Let me explain. At first, Congress felt content to ignore the issue and just pass band-aid legislation that stopped the cuts but avoided a true solution. However, approximately six in years past, we worked with Congressman Mike Burgess, M.D., to file legislation for a permanent solution. And, four in years past that legislation started getting some traction in Washington. Three in years past, the TMA held the Medicare Meltdown campaign, convincing 50 state medical societies and most 30 national and state specialty societies to sign our petition on Medicare and to actively advocate. This triggered a dramatic rise in the number of folks Congress calling for the permanent solution. Two in the past, TMA got the Texas chapter with the AARP to finally support a lasting fix.

Last year, there was our most successful breakthrough. Until then, reluctant people in Congress fell back on the argument that there was no approach to pay for a permanent solution. However, recently, TMA and HCMS lobbied our congressional representatives to just accept that continuing to offer increases to hospitals, assisted living facilities, home health agencies, etc. (see the graph above), while cutting or giving no increases to physicians was patently unfair. We also convinced many in Congress they could spend on the SGR fix in the money that had been going to those other providers by means of increases.

TMA and HCMS been employed very hard to get us closer to a perpetual solution – which is the ultimate goal. At a minimum, we need a two-year fix to provide some certainty to physicians during this very uncertain in time the evolution in our health care system. Now, we need all in our members to obtain engaged. I am asking that you join with all the Texas AARP members and also the families of those women and men in our military who have earned access towards the best health care in the world. Tell your Congressman and your senator to stop playing games with people’s lives and livelihoods and support a perpetual SGR fix. Tell them you need to know what you are going to get paid by Medicare in order to run your practice. Tell them what you will have to do if your SGR isn’t fixed to keep your practice viable. Also, tell them they have to ensure which our seniors aren't deprived of entry to medical care. You can find your legislators’ contact details at With our combined voices, we should be capable to continue making advances with Congress.

I also encourage you to become a member of TEXPAC, which will allow that you help determine which candidates have the support of organized medicine. Go to to join.

Finally, I urge one to sign up for HCMS Direct—free email service on legislation—so that you usually stays current with the latest happenings in Washington and Austin. Click here to Choose your News - HCMS Direct.

Congress responds to pressure. Thanks for the work of Dr. Reddy, Houston Academy of Medicine immediate past president, Robert B. Morrow, M.D., and all in our leaders at TMA and HCMS, we've got accomplished a good deal. Right now, we've the AARP and military families pressuring Congress to correct the SGR. We must possess the voices of all of our own physician members to add to that pressure. For your patients plus your practice, take time, result in the calls, and earn your voice heard! Join me and also the 2012 HCMS officers once we tackle Medicare and other challenges ahead.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

The Interdisciplinary Team; The Role of the Psychiatrist

by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication