Despite the Senate pushing back a possible 21% physician Medicare reimbursement cut until October 1, physicians continue to look for ways to stop the fiscal bleeding.
J. James Rohack, MD, president of the American Medical Association, says he has heard anecdotally from the AMA membership that physicians are taking steps to allot certain days to see Medicare patients, and not see them on others.
"There are physicians who may not drop out of Medicare, but limit the number of patients, in response to the current unsustainable situation," Rohack said last week.
As of now, the proposed Medicare cuts are in abeyance. Because the House has not yet voted on a Senate extension that would delay the proposed 21% Medicare reimbursement cuts until October 1, the cuts would take effect April 1, the end of the most recent extension that both houses approved, physician groups say.
As far as physicians are concerned, it's now back to the House to fix the fix on the sustainable growth rate formula. Physicians are still pushing for elimination of the SGR.
The SGR links Part B Medicare reimbursement to the gross domestic product (GDP). The formula has required large cuts annually through most of the decade and physicians have worked to continually oppose them and want to get rid of the formula.
"There's an old saying in Texas—if you are going to swallow a frog, the longer you look at it, the bigger it gets, and they are going to have to swallow this thing and they better swallow it now," Rohack says, referring to continued SGR delays and mushrooming deficits.
Meanwhile, the American Association of Family Physicians has sent more than 6,000 messages to Congress "vigorously" objecting to the possible cuts since February 1.
"It's really unclear what pathway the House is considering to change the situation," says Robert Bennett, a government affairs representative for the Medical Group Management Association, referring to the lower house's inaction in the wake of the Senate decision to extend the 21% pay cut to October 1. The MGMA represents medical group practice leaders and administrators.
"So now we are looking toward the April deadline, and then Congress will have a recess, and they are really running out of days," Bennett said. "There are rumors they may consider another 30-day extender. It may be a backburner issue for [Congress], but it's still a No. 1 issue for us. We really believe they have to address this issue once and for all."
Bennett adds, however, that it is still possible for the House to act on the matter this week.
The Senate vote for the October 1 extension isn't much help either, Rohack says.
"Who knows what will happen in October—a new fiscal year? It's going to cost too much and there's too much instability," Rohack says. "This is a budget gimmick. Temporary patches keep the process going, but it isn't solving a chronic problem."
The House had earlier agreed to eliminate the SGR, but the Senate voted to shut down efforts to repeal it. The bill would have reset the SGR formula to zero and eliminated $245 billion in debt that has accumulated the past six years.
Suggesting that Congress will again take action on the physician cuts, HHS Secretary Kathleen Sebelius has said her department's proposed budget was based on zero growth rate for physicians over a decade, not the estimated 21.2% cut for Medicare.
The Congressional Budget Office has offered some alternatives to the SGR. One is freezing payment rates at their 2009 levels for the next 10 years. Another would provide annual adjustments alongside the Medicare Economic Index (MEI). The MEI measures the annual increase in the cost of medical practices. The AMA believes that payments should be based on the MEI, and not the SGR.
Robert Moffit, director of the conservative Heritage Foundation's Center for Health Policy Studies, says the whole SGR imbroglio has resulted in "political damage" to the AMA and other groups because of their endorsement of a Senate healthcare reform bill without assurances that the "doc fix" would take place.
"You can't have it both ways? a deficit neutral Senate bill and the doc fix," Moffit says. "I think [the AMA] did it because doctors are desperate and locked into a system which has been created by Congress."
"The system has nothing to do with the conditions of supply and demand and interactions between doctors and patients in the delivery of medical services. It's crazy, but that's the way it is," Moffit says. "We have one set of bizarre formulas on top of another set of bizarre formulas. Congress is playing the role of the mad scientist making sure the Frankenstein monster doesn't get out. I think we ought to kill the monster."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
