Congressional inaction means cut to Medicare physician payments looms, delay expected

Although Congress failed to save physicians from the 21.3 percent reduction in their Medicare reimbursement slated to take effect tomorrow, doctors are promised that the cuts won't be enacted during the Senate's two-week recess, after which yet another one-month delay to the bill is expected.

Observers suspect that legislators have drawn out addressing the flaws in the Sustainable Growth Rate formula because of the large costs already linked to health reform, reports Becker's Hospital Review.

Although physicians would like to abandon the SGR in favor of the Medicare Economic Index, which would cost $556 billion in extra federal funding over the next 10 years, an eventual partial fix of the SGR is more likely, according to law firm EpsteinBeckerGreen. Under this scenario, Congress would allow evaluation and management codes to rise, based on the MEI, while maintaining the SGR for major and minor procedures, anesthesia, imaging and testing. Funding would come from reserves earmarked for reforming the Medicare payment system for physicians, created in the House Budget Committee's budget resolution for FY 2010.

However, an informal American Medical Association poll found that 68 percent of physician respondents would limit the number of Medicare patients they could treat when the cut takes place. Another poll from the American College of Surgeons and Operation Patient Access indicated that more than one-third of surgeons and anesthesiologists would change their Medicare status to nonparticipating if the cuts when into effect. This year's deadline to change Medicare status passed March 17.

"Physicians will be forced to limit the care they can provide to Medicare patients when payments fall steeply below the cost of providing care," J. James Rohack, AMA president, said.

For more information:
- read this Becker's Hospital Review article
- check out this MGMA article
- read this BusinessWeek piece