Senate Democrats are inching closer to approving an amendment that would finally reinstate physician Medicare payment rates to the March 31 level—at least until June 1.
An amendment proposed by Senate Finance Committee Chairman Max Baucus (D-MT) was approved in a 60-40 vote Wednesday night that would stop—at least temporarily—the 21% cut in physician reimbursements mandated by the sustainable growth rate (SGR) formula.
The amendment calls for exempting the payment provision from a Senate rule that says all spending legislation must be paid for under the Senate's "pay as you go" rule.
The full bill that is currently under debate calls for temporarily extending funding for several other federal programs that have expired, including unemployment benefits and COBRA benefits.
That bill is expected to be voted on by the Senate today or tomorrow.
Physicians have not encountered the cuts that went into effect April 1 because—for the second time this year—the Centers for Medicare and Medicaid Services (CMS) called for Medicare contractors to hold claims for performed services for the first 10 business days of the month (which expired yesterday).
J. James Rohack, MD, president of the American Medical Association, said Thursday that physicians remain in "limbo" waiting for Congress to act.
"This continued uncertainty coupled with the fact that Medicare payments, even without the 21% cut, have not kept up with the cost of providing care to seniors demonstrates the need for a permanent solution to this annual problem."
Rohack said 25% of Medicare beneficiaries are already having trouble finding a primary care physician. Cutting the payment will not help matters.
"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," he 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," he added.
Meanwhile, Ted Mazer, MD, a California Medical Association trustee, says he is frustrated about the issue.
"The failure of Congress, in particular the Senate, to act to correct this problem not only now but year after year highlights the inability of our legislators to deal with the real economic issues in access to medical care and is driving physicians away from continuing their participation in the Medicare program. The delay in this vote will result in increased costs to both Medicare and physician offices as payments are now made at 21% reduction since April 1, only later to be adjusted by retroactive payments, requiring two check cuts by carriers and double the work or more in physician offices across the nation to adjust payments and copayments a second time.
"It will also lead to confusion for patients and issues with secondary payers. And then the best we can hope for is just another delay in reaching a permanent fix of this horribly broken formula," he says.
On that topic, Joseph W. Stubbs, MD, FACP, president of the American College of Physicians (ACP), said, "There's the additional wrinkle that doctors may have to go back and re-bill patients for higher co-insurance once the payments are restored retroactively. If Congress then applies some short-term fix—be it for six weeks or six months—the added cost of rebilling will just add to the chaos."
"The only effective answer for patients and physicians, who operate small businesses, is a long-term solution to physician payments that provides predictable, positive and stable updates that keep pace with practice costs," said Stubbs.
Mazur says the doctor payment issue also causes some doctors to wonder about whether expanding government programs is the way to go.
"If nothing else, this repetitive politicization of needed payment reforms and corrections in the Medicare and related Tricare programs gives pause to physicians with respect to the future of expanded government payment programs and the reliability of the legislative process in maintaining and expanding access to care," says Mazur.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.