A “lot of nervous waiting and uncertainty” plagued Waco-based doctors Monday as a 21 percent cut in Medicare payments went into effect, the president of the McLennan County Medical Society said.

Physician groups warned for weeks of an impending “Medicare meltdown,” saying if the planned cuts were allowed to take effect, many doctors eventually would refuse to treat Medicare patients.

Doctors were hoping Congress would pass a measure postponing the cuts. But, unlike in past years, that fix didn’t come in time.

The House passed a bill last week that would have temporarily staved off the cuts. But the Senate failed to act on the one-month fix because Republican Sen. Jim Bunning of Kentucky objected that the $10 billion measure would add to the deficit.

Republican leaders have since pledged to help pass the temporary legislation, and President Barack Obama’s administration is ordering Medicare billing contractors not to pay claims from doctors for the first 10 days of March.

The hope is that the cuts will be reversed in the interim.

Medicare, a federal program, predominantly covers people older than 65. It also provides care to younger people who are disabled.

The cuts also affect Tricare, which covers military personnel and dependents.

The situation has many physicians in the Waco area anxious, said Dr. Bradford Holland, an ear, nose and throat specialist who heads up the medical society.

Medicare’s payments to doctors are already below market rates. If the cuts stand, doctors won’t be able to see as many Medicare patients — or in some cases, any at all — and stay open, he said.

In his practice, Holland said, Medicare pays him about $11 per hour to see a patient.

“To break even is tolerable to a point,” Holland said. “But if it starts to go into the red, then I’m going to have to limit or not accept new (Medicare) patients.”

Dr. Rima Bishara, a Waco-based internist, had the same concern.

She said she loves caring for Medicare patients, which make up about 60 percent of her patient load. But if the cuts remain, she will be forced to make tough choices.

Once overhead is figured in, she would be losing money on each Medicare patient she saw, she said.

“I still have to pay the bills,” Bishara said. “If this doesn’t get reversed, it will be devastating.”

Dr. Rodney Brown, of Waco Cardiology Associates, said his group likely would not cut back on seeing Medicare patients, since they make up half the practice.

But the cuts would have to be absorbed somewhere, likely through reducing overhead, he said.

“That very may well result in job cuts, and that’s paralyzing to our community,” Brown said. “This is not just a 21 percent cut in physicians’ pockets. It’s a 21 percent reduction in the money used to run an office.”

Dr. William Peper, who has a vein surgery practice in Waco, urged residents to contact their U.S. representatives and senators.

Although the situation now is particularly dire because Congress allowed the cuts to go into effect, things won’t be much better with a temporary fix.

Year after year, Congress has failed to fix the underlying funding formula, causing an annual scare for physicians.

“We can’t keep jerking them around,” Peper said, referencing doctors and the patients who depend on them for care.

The cuts are the consequence of a 1990s deficit reduction measure that Congress has routinely waived through the years.

Every time the cuts are postponed, they get bigger in percentage terms, making a permanent fix more costly and difficult.

cculp@wacotrib.com

757-5744

The Associated Press contributed to this story.