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Senior Citizen Politics
Doctors Face 21% Medicare, TRICARE Pay Cut Tomorrow
Without Congressional Action
Many physicians expected to no longer treat Medicare,
TRICARE patents at lowered pay rate
 April 14, 2010 April 15 is a costly deadline for
many Americans filing their taxes on deadline day. But it could even be
more costly to many doctors facing a 21 percent pay cut from Medicare if
Congress does not act immediately. Efforts by Democrats to fix this
glitch in regulations that make the pay cut mandatory have been blocked
by Republicans. Seniors and patients in TRICARE, too, could be big
losers, as it is considered certain many physicians will no longer
accept Medicare or TRICARE patients if this pay cut is finalized.
Current law requires the Centers for Medicare &
Medicaid Services to adjust the Medicare Physician Fee Schedule (MPFS)
payment rates annually, based on an update formula which requires
application of the Sustainable Growth Rate (SGR) that was adopted in the
Balanced Budget Act of 1997.
This formula has yielded negative updates every
year beginning in CY 2002, although CMS was able to take administrative
steps to avert a reduction in CY 2003, and Congress has taken a series
of legislative actions to prevent reductions in CYs 2004-2009.
The recommended cuts in the past have been far
smaller than the 21.2 percent reduction mandated this year, which was
announced in late 2009.
On March 1, the doctors were to be hit with the 21
percent reduction in the amount they are paid for treating Medicare and
TRICARE beneficiaries. Efforts by Democrats to correct this mandated
reduction has been blocked by Republicans. Physicians, meanwhile, are
talking of reducing services to senior citizens on Medicare unless the
pay cut is reversed.
Democrats and the American Medical Association were
able to delay the implementation date to April 1 but were still unable
to budge Republicans.
The Obama administration directed Medicare billing
contractors to hold off processing claims for 10 business days in the
hopes that senators could break the deadlock before lower payments are
issued.
Medicare normally pays doctors about 14 days after
bills are submitted, which would mean the pay cut can be avoided until
April 15.
Still, however, Congress has not acted.
 "Congress has already missed the deadline for new
legislation to block cuts of 21% in Medicare payments to doctors,
according to
The Wall Street Journal's Health Blog.
The pay reduction officially took effect April 1,
but the Centers for Medicare and Medicaid Services the federal agency
that oversees the giant health systems put a hold on processing
physician payments for 10 business days, effectively pushing off the
bite on payments for physicians' services until April 15. So that's the
new deadline facing Congress if it wants to pass a new law delaying the
cuts from really going into effect" (White, 4/13),
The Denver Post says, "Doctors say another temporary fix is
inadequate. Instead, they are pushing for a permanent change in law, a
solution estimated to cost about $220 billion over the next decade.
... Medicare patients typically are more complicated to treat more
diseases, more prescriptions to manage. ... Under the previous rates,
doctors were paid $95.43 by Medicare for a new-patient visit. The cuts
that went into effect April 1 knocked the reimbursement down to $75.20,
according to the Colorado Medical Society." The Post interviewed a
patient whose doctor "fired" her, saying the Medicare reimbursement is
inadequate (Brown, 4/14).
Meanwhile,
The Green Bay Press Gazette reports: "Wisconsin doctors and
hospitals treating Medicare patients can expect a modest bump in pay as
a result of provisions in the new health-care law. U.S. Rep. Ron Kind,
D-La Crosse, and a group of lawmakers from the Midwest and Pacific
Northwest fought hard to get them," withholding support of the health
reform bill until they negotiated a deal. "What they got was $800
million for immediate payments for doctors and hospitals and a
commitment from the administration to a value-based system for paying
physicians and other providers." The changes affect doctors in the
Midwest and Pacific Northwest who have "traditionally have received less
for treating Medicare patients than their counterparts in other parts of
the country" (4/14).
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Some
of this
information was reprinted from
kaiserhealthnews.org with permission from the Henry J.
Kaiser Family Foundation. You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign up
for email delivery. © Henry J. Kaiser Family Foundation. All
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