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As regulatory pressure on practices mounts, would more performance incentives and a more stable physician payment system induce physicians to continue serving Medicare patients?
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Permanent Medicare physician pay cut not likely
 Michael X. Repka |
Despite the combined efforts of physicians of all specialties, Congress was unable to replace the sustainable growth rate, deciding to pass yet another temporary fix that will last until November 30, 2010. At that time, physicians caring for Medicare patients will owe the U.S. Treasury in excess of $220 billion, and we will once again be at risk for 21% or greater cuts during the lame-duck Congress. It seems unlikely that Congress would let a permanent reduction happen, given the likely access issues that would quickly develop among beneficiaries.
In addition to fixing payment instability, it is time that Congress recognizes that physician payments have fallen well behind the rate of medical supply inflation and solve the sustainable growth rate problem. Medicine should be involved in determining this fix. A repeat of 2010 is not a sound financial model for health care. Unfortunately, the sustainable growth rate solution will likely come with new responsibilities, reforms and penalties for participating providers, such as limits on new technology, comparative effectiveness benchmarks and quality outcome measures. Stakeholders will need to carefully evaluate these limits to determine the best balance between payment stability and payment reform allowing their continuing participation in the program.
Michael X. Repka, MD, is the American Academy of Ophthalmology’s secretary for federal affairs. He practices at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.
Pay cuts will force physicians to drop Medicare
 Brock K. Bakewell |
As the sustainable growth rate debacle continues with no permanent fix, doctors are becoming more and more disenchanted with participation in the Medicare program because of poor reimbursement that does not keep up with the ever-increasing expenses of running a practice.
Some ophthalmologists with large Medicare patient populations are opting out of Medicare. In December 2010, physicians who participate in Medicare will be facing a 23% cut in reimbursement for professional fees. This translates into a 46% cut in physician take-home pay! (This assumes 100% of practice revenue comes from Medicare.) This is totally untenable for physicians who are running a practice with payroll and other fixed costs. Therefore, physicians need a permanent fix to the sustainable growth rate to create a stable practice environment so they can continue to care for Medicare patients. If this happens, it will help to slow the defection by physicians from Medicare and preserve Medicare patient access to physicians.
Concomitant with stagnation of physician fees over the past 10 years, performance incentives such as the Physician Quality Reporting Initiative have been a failure because of the amount of work involved for the minimal increase in payment. A high percentage of physicians who participated in the Physician Quality Reporting Initiative in 2009 did not receive the promised reimbursement. Also, the Obama health insurance reform, the Patient Protection and Affordable Care Act, makes the Physician Quality Reporting Initiative punitive, so that physicians who do not participate will start receiving punitive cuts in reimbursement starting in 2015.
In my opinion, Medicare is very important for our elderly, but it is a defined benefit plan that is oversubscribed and underfunded. It needs to be changed to a defined contribution plan, with patients able to upgrade their level of benefit by contributing their own capital. This will make patients better health care consumers and will also help to reduce government spending on Medicare.
Brock K. Bakewell, MD, FACS, is chairman of the American Society of Cataract and Refractive Surgery’s Government Relations Committee, co-director of Fishkind, Bakewell & Maltzman Eye Care and Surgery Center in Tucson, Ariz., and is assistant clinical professor of ophthalmology at the University of Utah.