Winter of Medicare Discontent Could Await Docs

June 28, 2010
Keith L. Martin

Just when it seemed there was a temporary reprieve to physicians’ concerns about declining Medicare reimbursements comes word that the winter could be a tougher season than initially expected.

Just when it seemed there was a temporary reprieve to physicians’ concerns about declining Medicare reimbursements comes word that the winter could be a tougher season than initially expected.

Last week, President Obama signed into law a provision delaying a proposed 21.3 percent reduction in payments required under the current sustainable growth rate (SGR) formula through Nov. 30. The measure also came with a 2.2 percent payment increase for services beginning on June 1.

The six-month delay did not sit well with associations representing physicians’ practices nationwide, including the AMA and the Medical Group Management Association (MGMA). The latter group’s president and CEO, William F. Jessee, said the short-term solution by Washington, D.C., “belies the fact that Congress continues to act irresponsibly in addressing the flawed SGR formula.”

Now comes an additional proposal from CMS to enact another 6.1 percent cut in physicians’ Medicare reimbursements in order to implement provisions of the Patient Protection and Affordable Care Act. The proposed cut would take effect on or after Jan. 1, 2011.

This cut, if approved, in addition to the looming cut delayed by Congress means that by the time docs hang up their new 2011 calendars, they could be facing a nearly 30 percent total cut in their reimbursements. AMA President Cecil Wilson accused Congress of “playing a dangerous game of Russian roulette with seniors’ health care” with the all the cuts they are facing.

The proposed rule by CMS would propose changes to the physician fee schedule and other Medicare Part B payment policies, “to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services,” the federal agency said in the text of its proposed change.

The rule is being proposed to “eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit,” CMS said, and also discusses payments under the Ambulance Fee Schedule, Clinical Laboratory Fee Schedule, payment to ESRD facilities and payments for Part B drugs.

Docs and others with concerns can weigh in with public comments by Aug. 24 with a final rule to be issued by Nov. 1, according to CMS.

So docs may want to enjoy their summer as much as they can because it looks like the “fall” is coming with a tough winter to follow.