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Medicare physician payment cut stalled again
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On Friday, the House of Representatives voted 245-171 to pass an extension of the 19-month sustainable growth rate fix, which would delay the 21.1% reduction in Medicare physician payments through 2011. However, the Senate adjourned for the Memorial Day recess without voting on the package, leaving the Medicare cut to go into effect today.
Congress will have to stop the cut retroactively when it returns after the recess on June 7.
The Medicare payment cut was originally scheduled to take place on Jan. 1. This is the third time since February that the bill has been stalled.
The Centers for Medicare and Medicaid Services has instructed Medicare contractors to hold claims for the first 10 business days in June to allow time for Congress to complete its action and overturn the scheduled payment cut. Under current law, clean electronic claims are paid no sooner than 14 calendar days following receipt of the claim (29 days for paper claims).
In a statement from the American Medical Association (AMA), J. James Rohack, MD, president of the association, said, “Enough is enough: Nine times in eight years Congress has delayed the cut and not fixed the problem.
“The Senate has turned its back on seniors, and America’s physicians are outraged that Congress has deserted patients by failing to address this year’s Medicare cuts before the June 1 deadline. Senators are more interested in heading home for the holiday than in preventing a Medicare meltdown for seniors. Congress needs to buckle down, stop growing the problem, and fix it once and for all to save the Medicare and TRICARE programs for American’s seniors and military families.”
On June 3, Rohack is scheduled to announce a multi-million dollar AMA campaign urging Americans to call their senators to help avoid a Medicare meltdown. “The AMA will not sit silent while Senate inaction guts Medicare’s physician foundation,” Rohack stated in an AMA release.
J. Fred Ralton, Jr., MD, president of the American College of Physicians, said “Congress’ recurring failure to enact a long-term plan to replace the SGR will result in bigger cuts and greater budget outlays in the future. Now, Medicare increasingly is viewed as an unstable and unreliable payer of services, with the result that more and more physicians will likely have no choice but to limit how many Medicare and TRICARE patients they can afford to accept in their practices.”
The majority of orthopedists I have spoken with, including my partners, will be beginning partially or drastically reducing the number of Medicare patients that they see if these cuts take effect. There has been a local threat by some area hospitals that in order to maintain hospital privileges, staff bylaws have been amended to predicate hospital privileges on physicians caring and treating Medicare patients. This bylaw requirement can only pertain to emergency patient care however, and if elective cases are drastically reduced, wait times for elective procedures and diagnostic tests could easily rival those in Canada or Europe. For example, some orthopedic surgeons who do total joint replacement have stated that they will do only one Medicare total joint per week and see private pay patients in the remainder of their clinic schedules. With the number of total knee and hip arthroplasties expected to triple over the next 10 to 15 years, this will create a significant backlog of total joints for those patients with Medicare insurance only. The sad reality is that as it stands, with increasing overhead costs for the private practicing orthopedist Medicare reimbursements barely cover the cost of seeing a patient in the clinic. With the proposed decrease in reimbursement, it will be unprofitable to see patients who only have Medicare insurance in the future.
– Jack M. Bert, MD
Orthopedics Today Business of Orthopedics Section Editor
