Joseph Rugg's Health Law Blog

These are tough times, and physicians are facing some serious issues in Medicare reimbursement.

 The AMA recently published an article dealing with this issue.  Here is the link to the AMA article.  The article begins as follows: 

To date, despite its clear recognition that the physician payment formula is fatally flawed and needs to be abandoned, Congress has once again missed an opportunity to permanently repeal the sustainable growth rate (SGR) formula.  With the Joint Select Committee on Deficit Reduction failing to reach agreement on a deficit-reduction proposal, physicians still face a 27 percent cut in Medicare physician payments scheduled to take effect Jan. 1.

 Meanwhile, Medicare carriers have distributed information to determine if physicians want to modify their status as participating or nonparticipating physicians. The AMA has developed the “Know your options: Medicare participation guide” to help physicians evaluate their options and choose the direction that is suitable for their practice.

The article and the Medicare Participation Guide are worth reading. 

On the heels of these concerns, the Americvan Health Laywers Association has reported the following two stories:

Pay Cuts Spark Debate.

The Washington Post (12/4, Aizenman) reports, “The impact of mandatory Medicare pay cuts triggered by the congressional debt panel’s recent failure to reach a deal is the subject of sharp disagreement.” Physicians “and hospital officials are warning that the cuts could have serious repercussions for American healthcare, prompting many doctors to drop Medicare patients and forcing hospitals to lay off staff and consolidate facilities.” But “prominent healthcare analysts — including those serving an independent agency charged with advising Congress on Medicare — suggest the problem is not that doctors will be short-changed, but that most will continue to be paid too much.”

House Republicans Plan To Block Medicare Physician Payments Cuts.

CQ (12/5, Ethridge, Subscription Publication) reports, “House Republicans said Friday that they plan to block pending cuts to Medicare physician payments in a year-end legislative package that would extend several expiring tax and benefit provisions.” The piece notes that “it was unclear whether the patch would last for one year, like the current ‘doc fix’ (PL 111-309), or two,” while “physician groups have been pushing for an overhaul of the payment formula but would still favor a two-year patch over the yearlong fix they got last year.”

It’s clear that there are no easy answers, and certainly not even a consensus on whether there is a problem. 

Nevertheless, it’s hard to believe that Congress will not act in time to stop the scheduled SGR formula cut

Stay tuned.