I have worked in central Maine for more than a decade and have treated thousands of Medicare patients, initially as a family doctor, and now as an emergency physician.

Since transitioning to emergency medicine, I have been continually dismayed to see that, unfortunately, emergency care is often the only option for so many of our seniors who have difficulty finding a primary care provider still able to accept Medicare. Emergency visits don’t provide optimal care for seniors, but with more and more primary care physicians opting out of Medicare or limiting their Medicare patients, seniors have no other choice.

This reticent Congress has failed to fix the Sustainable Growth Rate — or SGR — the fatally flawed formula that determines Medicare reimbursement rates for physicians.

As our legislators know well, the current system is unstable and unsustainable, and fails to account for the actual cost of providing medical care to seniors.

With another 30 percent cut to Medicare reimbursements scheduled to take effect in January 2012, the time is now to institute a long-term solution.

These cuts and the uncertainty they create for patients and physicians have a profound impact on the ability of doctors to provide care to Medicare patients.

Five years ago, solving the problem would have cost just $50 billion. Today, the cost is $300 billion, and five years from now, it will be $600 billion. Congress does have the opportunity to end the years of procrastination in fixing the payment formula, and institute a solution.

As part of its deficit reduction recommendations, the Congressional Super Committee should include a permanent fix to the flawed SGR. The bridge to the future of Medicare is strained by the weight of this unfunded liability.

It’s time to stabilize our nation’s largest health care program and fix the SGR.

Joel A. Kase, DO, MPH

immediate past president, Maine Osteopathic Association

Lewiston

Shift to patient-centered care must be broadened

Jim Kerney’s column about Medical Homes reported a major revision in thinking about primary health care (“Got patients? Doctors exploring new approach to health care in Maine,” Oct. 10).

Emphasis needs to be focused on the shift to prevention-based care, a focus made possible by a parallel shift in payment mechanism. As Kerney notes, fee-for-service payment is being transitioned into capitation, a per-person per-month arrangement. What is not discussed is how this latter form must be flexibly designed to allow primary-care interdisciplinary teams to create individualized practice possibilities for their patients, especially their patients with chronic disease.

This shift, from payment-centered to patient-centered care, must also be broadened in the medical home concept to allow for primary care sites to build care managers, social workers, and other disciplines into the team working with empowered patients as active partners to the team’s deliberations and treatment planning.

This is particularly important for patients who come from vulnerable populations, patients most likely to have multiple or complex, interacting chronic illnesses. Further, many of these patients come from poverty-immersed homes — a reality that creates distinct disadvantage when it comes to adequate resources for health and healing (e.g., adequate employment, housing, or health insurance).

The extent to which medical care is complemented by patients’ self-management responsibilities will predict medical outcomes.

Medical outcome attainment is a prerequisite for capitated medical home models of care.

This assumption is based upon evidence garnered in support of these concepts. Turning staff into empowering patient advocates with medical and related skill sets brings the patient into partnership and distributes the responsibility for producing outcomes.

We can’t forget this crucial aspect of medical homes. To do so would short-circuit the creative and cost-effective possibilities medical homes present.

Stephen M. Rose

Portland

In addressing issues of life, God does not negotiate

I am responding to the Oct. 15 Another View (“Marriage equality law would be consistent with religious liberty”) in which Steve Wellcome states, concerning same-sex marriage: “Allowing same-sex marriage would curtail the power of one religious group to impose its beliefs on another.”

He argues from two false premises. The first is that with or without same-sex marriage, there will be winners and losers. Either way, one will be imposing its will on the other.

The second is that, while the same-sex debate has become a dividing issue between organized religions and political parties, the fact is, from a biblical standpoint, it is a personal conflict between the will of man and a holy God.

God declares very clearly in both the Old and the New Testaments that the practice of homosexuality is an abomination in his sight and that each individual will be accountable to him. Equally sobering is the truth found in Romans 1 that those who approve of sinful behavior are also guilty. According to God’s word, this includes those legislators who legalize sinful behavior of any kind.

In addressing the issues of life in Scripture, God does not negotiate, he declares. The late Dr. Donald Gray Barnhouse, noted Presbyterian minister and author, said it well: “God therefore has given us the Bible as the supreme court from which there is no appeal.”

The miracle of the Bible message is that while God hates sin, he loves each of us, and when we come to him in repentance through his son Jesus Christ, we can find forgiveness and the promise of eternal life.

Donald A. Yeskoo

Wells

Celebrity contributes to marriage mockery

Well after spending $10 million on the wedding, according to online news reports, it appears that Kim Kardashian is going to file for a divorce from Kris Humphries — after 72 days. Yes, after 72 days. According to a friend of the future divorcee, “She feels like she made a mistake.”

After 72 days, could someone please tell me this doesn’t minimize the sanctity of marriage.

What happened to the vows “for richer, for poorer, in sickness and in health”?

Dennis Ouellette

Saco

 

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