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Medicare Physician Payment Cuts Delayed (Again)

Congress approved, and President Obama signed, legislation Thursday night to delay 21% payment cuts in Medicare reimbursements to physicians through May 31.  The cuts were due to go into effect on April 1, but CMS agreed to delay processing claims for 10 business days to April 15 in anticipation of last night’s action.  This is the second time this year that CMS has held claims and Congress stepped in to temporarily delay the cuts.

Since healthcare reform law has recently passed, it’s unlikely that a permanent fix to the sustainable growth rate (SGR) is near.  Come June 1, a similar temporary fix is most likely to occur, which does not sit well with physicians or the American Medical Association.

J. James Rohack, president of the AMA, said “Congress’ inability to solve this problem once and for all through repeal of the broken payment formula will hurt seniors, military families and the physicians who care for them. It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care. In an informal poll, 68 percent of physicians tell AMA they will be forced to limit the number of Medicare patients they can care for. Already, about one in four Medicare patients seeking a new primary care physician are experiencing difficulty finding one.”

Lori Heim, president of the AAFP, offers a practical view on the timing and (lack of) urgency by Congress.  “They are in an election year, and nobody wants to be seen as adding to the deficit. It’s politically easier for them to keep putting off the doctors, rather than allocate $209 billion that it would take to do the permanent fix over 10 years.”  She said the next opportunity for physicians who take Medicare patients to opt-out of the Medicare program is June 1. Many physicians have threatened to stop taking Medicare patients if there is no permanent fix to the SGR.

According to the AMA, fixing the Medicare physician payment problem is essential to the stability of Medicare. If Congress fails to repeal the formula, the problem will continue to grow. Seven times in seven years Congress voted not to impose cuts triggered by the flawed payment formula, putting off paying for it until another day.

Dr. Rohack said “Congress’ inability to solve this problem has not only made it impossible for physicians to keep seeing all Medicare patients, it has more than quadrupled the price of a solution for taxpayers. It’s irresponsible to continue short-term fixes just as baby boomers begin aging into Medicare next year. Congress needs to make the better fiscal decision and the better decision for seniors and repeal the formula now instead of putting it off again and increasing the price tag for America’s taxpayers.”

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