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Medicare reform is in the news again.

Earlier this year, a public outcry stopped legislation to reduce Medicare's reimbursements to physicians and froze payments at current levels for just a year. The latest Medicare reform packages propose a 10 percent decrease in 2008, boosting the cuts to 40 percent by 2015.

Medicare reform is an ongoing project.

In 1983, hospitals were given a ceiling on reimbursements for in-hospital care. The Medicare Prospective Payment System that imposed the ceiling was the first large-scale reform, and it changed patient care forever. Using Diagnosis-Related Groups, the system classifies patients by their illnesses, ages, genders, illness complications, surgical procedures and how patients are discharged. The system ignores the actual costs of care - giving hospitals no choice but to cut services and redesign patient care using strict monetary guidelines.

In 1983, I began working for a durable-medical-equipment company. Our purpose was to provide medical equipment and oxygen to discharged patients who required hospital-style care at home.

At first, the reimbursement rates were good, and similar companies sprouted like weeds all over the United States. But the lucrative business of hospital equipment went under the reform microscope when audits revealed Medicare was paying unlimited monthly rental fees to suppliers - sometimes 20 to 30 times the actual cost of the equipment.

For example, a bedside commode cost a supplier about $35. Medicare's monthly rental reimbursement was $22, with no cap or time limit. One supplier made nearly $10,000 in rental payments for commodes in one year. This pushed the reform advocates into a fury, and Congress passed legislation setting payment and rental limits for all medical equipment. The reimbursement rates have continued to fall for medical equipment suppliers every year.

Now Medicare's payments to physicians are being scrutinized. Previous budget cuts have driven many doctors to avoid dealing with Medicare insurance or limit the number of Medicare patients they will care for. Doctors are financially drowning under Medicare paperwork to prove they should be paid at all. Accepting Medicare has become a liability instead of a guaranteed form of income.

I made a career for 17 years helping hospitals, medical suppliers and physicians fight for reimbursements for services rendered. I've been involved in countless hearings arguing why a spinal cord injury patient requires an electric wheelchair costing $25,000. All the delays and rejections of bona-fide claims drive patient care costs through the roof.

Medicare reformers say they are just hunting down Medicare fraud. OK, that's good. However, the line must be drawn when it comes to reimbursement rates. Cutting payments to unreasonable levels will not weed out fraud. It will only cause more anguish for Medicare patients and doctors who toe the line.