Medicare payments a sticking point for doctors
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%.”