The nation's physician workforce anxiously awaits the Joint Select Committee on Deficit Reduction recommendation to Congress on how to avoid the Sustainable Growth Rate (SGR) formula, which is poised to take the largest chunk in history?nearly two of every three dollars?out of their Medicare fees.
In the meantime, the epithets abound. American College of Physicians president Virginia Hood, MD, predicts "devastating access problems for patients" if the cut is allowed to stand, according to a statement released last week.
The American Academy of Family Physicians President Glen Stream, MD, says the cut would pose "a serious threat to the financial viability of physician practices" that provide care to one in four Americans. For some physicians, Medicare patients number 80% of their practices. It is "folly," he said in a news release.
And the American Medical Association's Peter W. Carmel, MD, said in a statement he sees "a looming crisis."
The 27.4% pay cut under the SGR formula is less than the 29.5% reduction projected last March, but it seems physician groups are not relieved one bit. The cut would mean practitioners who treat the oldest and the sickest patients would receive about $22 billion less nationally just in the formula's first year, which would begin in less than two months.
To stop the cuts and repeal the SGR would cost Medicare $293 billion over 10 years, by one estimate, if physician fees are merely frozen.
If these cuts, or even less draconian ones such as the $200 million in recommended reductions from MedPAC, the Medicare Payment Advisory Commission, take effect, physician groups predict doctors will reduce the number of Medicare patients they are willing to see.
Another result is that more doctors might retire earlier. They may also reduce the number of support staff in their offices, straining the workloads of those who remain.
According to Carmel, there's "already a 20% gap between Medicare payment updates and the cost of caring for seniors." This population needs more focus and supportive care, especially to manage chronic diseases and prevent avoidable hospitalizations, he says.
Numerous alternatives are being floated within the Beltway. One, according to a Nov. 3 report in the journal Health Affairs, was proposed by the Bowles-Simpson Commission, also known as the National Commission on Fiscal Responsibility and Reform. This would freeze doctors' paychecks through 2013, reduce them by 1% in 2014, and reinstate the SGR in 2015 with 2014 as the base spending year. This plan would cost $261.7 billion over 10 years, according to analysis by the Congressional Budget Office.
The White House wants to repeal the SGR, estimating a 10-year cost of $293 billion.
MedPAC would freeze primary care physician pay, but impose a 5.9% reduction in reimbursement for specialists, which the commission estimates would cost $200 billion over 10 years.
Of course, there's always the option of continuing to "kick the can down the road," further delaying the imposition of the SGR formula for another year, which would mean the pay reduction scheduled for 2013 would be even more untenable.
According to Hood of the ACP, "enacting a short-term fix to prevent the January 1 cut will add hundreds of billions of dollars to projected Medicare spending compared to a permanent solution, continue to endanger patient access to doctors, and create roadblocks to promising new models to improve outcomes and lower the costs of care."