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Do I hear someone kicking a can?

Posted Nov 11 2010 2:04am
Robert Lowes, in Medscape Medical News (sorry, password protected) reminds us
Physicians face a 23% cut in Medicare rates on December 1 and another on January 1 that pushes the total to roughly 25%. Both are triggered by the controversial sustainable growth rate (SGR) formula that Medicare uses to set physician pay. Put simply, the reductions represent the program's attempt to collect several hundred billion dollars that it has overpaid physicians since 2002. This debt has built up because every year Congress has postponed SGR-mandated reductions. The cost of merely freezing current Medicare rates through 2020 as opposed to cutting them as planned would amount to $276 billion, according to the Congressional Budget Office.

Kaiser Health News says:

If Congress fails to overturn the cuts this time, doctors could reconsider taking new Medicare patients* or change how they participate with the program, (AMA President) Wilson warned in an interview with Kaiser Health News. "What we're saying to them and what we want seniors to say to them is, 'You're threatening our access to care. If physicians cannot keep their doors open because Medicare now only pays about half the direct cost of running a practice, then we're going to lose access to care,'" Wilson told Kaiser.

Another article notes,

The AMA is campaigning for a 13-month extension, rather than a shorter extension until Congress reconvenes next year, taking advantage of the completely Democratic Congress. The Democrats will put the cuts on the legislative agenda this month.

Of course, the trade organizations for every physician group are also at work on the issue, from optometrists to family practice doctors to hematologists .

Most people think that Congress will just kick the can down the road a bit more with a short-term postponement. Why? Because a permanent fix would bust the federal budget rules. A reminder, too: The Congressional Budget Office analysis of the recently passed health care bill assumed that this reimbursement reduction would go ahead as planned.

I don't know what long-term fix will be used for this problem. Thoughtful observers like BU's Austin Frakt have come up with proposals, but such plans are unlikely to be adopted during a lame-duck session.

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* I do not believe this option is open to private practice doctors in Massachusetts. Can someone validate that for me? In any event, though, hospitals and doctors working in hospitals cannot exercise this option.
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