As many as 55,340 health care jobs could be lost in Florida by 2021 as a result of the 2 percent sequester of Medicare spending mandated by the Budget Control Act of 2011.
"Florida ranks second-highest among all 50 states in the number of potential jobs lost," said Florida Hospital Association President Bruce Rueben. "As hospitals are forced to lay off health care workers, services will be reduced and access to quality care for all Floridians will be negatively impacted."
Nationally, more than 760,000 jobs would be lost, according to the joint report from the American Hospital Association, the American Medical Association and the American Nurses Association.
John Sielert, Boca Grande Health Clinic CEO
John Sielert, Boca Grande Health Clinic CEO, said Medicare spending cuts would harm the bottom line.
"These movements plus the impact from the Budget Control Act of 2011 could have a huge impact on physician practices, not to mention the rest of the health care industry," he said. "If you lower reimbursement to physicians they have a couple of choices: lower their own income or reduce their operating costs. Labor is the single-largest expense in a medical practice."
But Sielert said the Medicare picture is much murkier than the report indicates when all issues are considered.
For example, Sielert said the report failed to take into account the impact of thousands of Baby Boomers turning 65 every day.
"In my review of the summary report on the study, I do not see any consideration for the growth in spending required to cover the increase in enrollment in Medicare resulting from the aging of the Baby Boomers," Sielert said. "The increased demand will probably result in an increase in spending regardless of the proposed reductions.'
In the short run, Sielert said, the report could be right. However, by 2021 patient demand will result in more spending - not less, he said.
"This may not mean a reduction in jobs but a loss in future job growth," Sielert said. "Don't get me wrong. The impact will be felt but most health care providers will be faced with providing more services with fewer resources than they otherwise would have. "
The congressional partisanship wars could also create significant medical field casualties, Sielert said. The Sustainable Growth Rate formula Medicare uses to adjust payment rates for physicians would require a 27 percent cut to Medicare physician fees in 2013.
" The SGR regulation has been in place for more than a decade but each year Congress has waived it and added the required reduction to the next year," Sielert said. "If Congress does not act to either waive it again or repeal it then that reduction would go into effect. This has gotten to a point that it would be ridiculous to envision it happening. This alone would devastate the physicians across the country.
"However, given the climate in Washington where both sides have been digging their heels in over issues, it might have unintended consequences. Hopefully not."
The technological revolution is also a contributing factor. A federal program designed to incentivize physicians to begin using electronic health records in their practices will begin reducing payments by 1.5 percent to 2 percent to those physicians not using them by 2015.
Sielert said it is estimated only 35 percent of physicians are now using electronic health records. That trend is on the rise so by 2015 most doctors should be on a system.
"However I personally do not think that doctors in the last five or 10 years of practice will make the change," he said. "Those doctors also are likely to have more Medicare patients in their practice. So from that standpoint there may be some impact on a segment of the physicians."
The report, produced by Tripp Umbach, a firm specializing in conducting economic impact studies, measures the anticipated effect of the cuts in Medicare payments on health care providers and other industries. The model reflects how reductions in Medicare payment for health care services will lead to direct job losses in the health care sector, reduced purchases by health care entities of goods and services from other businesses, which in turn will lay off workers. As the impact of these cuts ripples through the economy, jobs will be lost across many sectors beyond health care.
This model estimates that during the first year of the sequester, more than 496,000 U.S. jobs will be lost.
The Bureau of Labor Statistics reports health care created 169,800 jobs in the first half of 2012 or one of every five new jobs created this year.
Sielert said the Boca Grande Health Clinic was just notified the Medicare fee schedule for 2013 will have a sizeable increase. Some specialty reimbursement increases may be as high as 7 percent.
"Go figure with all the talk of cuts," Sielert said. "The big question is how will all these different programs/initiatives net out: Will it be positive or negative?"