With­hold­ing pat­tern

Medi­care pay­ments a stick­ing point for doc­tors

Modern Healthcare - - The Week In Healthcare - Jen­nifer Lubell

While cau­tiously op­ti­mistic that the new health re­form law ad­dresses mea­sures to boost the physi­cian work­force, med­i­cal or­ga­ni­za­tions and doc­tors across the coun­try are nev­er­the­less fed up that Congress can’t de­liver on the one thing they want most: ad­e­quate Medi­care re­im­burse­ment.

For the past few months, a crazed dance has been tak­ing place in Wash­ing­ton, as law­mak­ers strug­gle to act in time to pre­vent a 21.2% cut to Medi­care physi­cian pay­ment. The CMS in turn does its part to de­lay the cut by briefly with­hold­ing pay­ment on Medi­care claims— which it did last week—un­til Congress fi­nally de­liv­ers on a stop­gap mea­sure. The re­duc­tions are caused by Medi­care’s sus­tain­able growth-rate for­mula, or SGR, which is tied to the health of the econ­omy and has been threat­en­ing pay­ment re­duc­tions since 2003.

Sev­eral weeks ago, the Se­nate failed to act on an­other tem­po­rary mea­sure to stave off the cut un­til the end of April, mean­ing that doc­tors will have to wait un­til law­mak­ers re­turn from spring re­cess to ad­dress the prob­lem. “I am so frus­trated that they have con­tin­ued to take tem­po­rary fixes at a time when we are try­ing to turn around and al­le­vi­ate physi­cian fears about what health re­form will mean. I think the tim­ing couldn’t have been worse,” said Lori Heim, pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians. Arthur Ru­bin, an in­ternist in Arlington, Va., said his prac­tice stopped tak­ing new Medi­care pa­tients be­cause of poor re­im­burse­ment and non­re­im­bursed ser­vices un­der this pro­gram. At one time, the Medi­care pa­tient base was 30% to 40%, but that’s no longer doable, Ru­bin said. “It’s now less than 15%,” he said, adding that the con­tin­ued un­cer­tainty of de­clin­ing Medi­care pay­ments “makes it hard to fig­ure out what to do about Medi­care pa­tients.”

Be­yond the SGR prob­lem, “there are lots of pro­vi­sions in this health re­form law to help deal with the pri­mary-care prob­lem in­clud­ing in­creased Medi­care and Med­i­caid pay­ments for pri­mary-care doc­tors,” said Robert Do­herty, se­nior vice pres­i­dent of gov­ern­men­tal af­fairs and pub­lic pol­icy with the Amer­i­can Col­lege of Physi­cians.

Ru­bin: Medi­care pa­tient base is “now less than 15%.”

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