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Docs Worried as Payment Cut Deadline Nears

John Commins, for HealthLeaders Media, February 24, 2010

Despite a stepped-up lobbying effort over the past months, leading physicians' groups appear resigned and exasperated with the idea that Congress will not take permanent action to fix the sustainable growth rate formula before 21% reimbursement cuts for Medicare take effect March 1.

While all but surrendering hope for a permanent solution to end the annual "doc fix" on Capitol Hill, physicians now wonder if an 11th hour temporary fix is doable.

"I don't see the vehicle that Congress can use to come up with that short-term fix," says Lori Heim, MD, president of the American Academy of Family Physicians. If the cuts are to be averted, at least temporarily, Heim says, CMS may have to step in.

"CMS can hold up payments for 15 days, which means that a cut won't go into place, but payments won't go out," she says. "Or CMS could keep paying on time, there will be a cut, but CMS will look to Congress to do a retroactive increase. Those are still two possibilities.

"Either way, physicians are going to start feeling the pinch right away. When your payments are delayed two weeks that means that predicting what your income is going to be starts getting up close and personal."

Cecil Wilson, MD, president-elect of AMA, says, "There is no clue out there [as to] what Congress' intent is. It's a mystery. From our perspective, Congress is diddling with partisan politics while letting Rome burn and not protecting access to care for seniors and the families of our military, all of whom depend upon Medicare and TRICARE."

"The later it gets, the closer it gets to the witching hour, the more concern we have. The thing to be done is to try to shame them into stepping up to the plate and assuming their responsibilities for seniors, military families, baby boomers who are going to be entering Medicare in 2011, when the first wave starts," Wilson says.

In 1997, Congress mandated Medicare spending cuts that were scheduled to begin in 2001. Those cuts have never taken effect, because each year AMA and other healthcare lobbying groups push Congress to delay the cuts. Each annual Band-Aid fix, however, makes the next year's cuts deeper. The latest 21% cuts were to have taken effect on Jan. 1, but Congress pushed the deadline back to March 1.

"There was some hope that during that 60-day window they would get a healthcare reform package done that would also pave the way to do an SGR permanent fix," Heim says. "Part of the problem is now there is still a desire to get healthcare reform done, but it is hitting more obstacles than many people anticipated, and the SGR has been captive to that whole process."

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