As Healthcare Finance News goes to print, physicians across the country were once again facing the prospect of a massive cut in pay, as CMS intended to reduce medical reimbursements to physicians by nearly 25 percent on December 1.
In this year's physician payment shell game, Congress has already delayed the pay cut four times. If past years are any indication, it's likely they would do the same during the lame duck session that bookended the Thanksgiving holiday.
While physicians would welcome another last-minute reprieve, doctors and Congressional leaders alike say a permanent fix to the badly broken reimbursement model is needed. The big hurdle is finding agreement on how to fix it.
A bill introduced in October by Sen. Debbie Stabenow (D-Mich.) which would have frozen Medicare payments at current rates for 10 years was ultimately defeated by a 53-46 vote in the Senate.
"The formula is complicated and does not reflect the reality of treatment costs," said Stabenow. "In fact, the formula has led to scheduled physician payment cuts for eight years in a row. Since the first cut in 2002, Congress used a band-aid approach that temporarily delays the cuts and pushes them off to the future."
After Congress failed to again delay the implementation of cuts before a June 1 deadline, the Centers for Medicare & Medicaid Services placed a hold on all claims filed after June 1 in an attempt to buy time for legislators. CMS lifted the hold mid-month and began processing claims with the 21 percent reduction with the intention to pay the difference retroactive to June 1 once an extension was passed.
With healthcare providers on a year-long reimbursement roller coaster ride, the question of Medicare patient access to doctors often took a back seat. But the threat of decreased physician participation in the program is very real. According to a survey conducted by the Medical Group Management Association, 67 percent of medical practices indicated they would limit the number of new Medicare patients they would accept, with half of all practices indicating they would not accept any new patients under the program.
The American Medical Association led more than five dozen healthcare and provider groups in calling for relief. AMA President Cecil B. Wilson said it would be a "catastrophe" if Congress failed to act in the lame duck session to block the pay cuts.
As the calendar approached December, the AMA was pulling out all the stops to avert the cuts. In early November, the association ran ads in USA Today and other news publications urging Congressional leaders to act and released survey results indicating 94 percent of Americans were concerned with the looming pay cuts. To AMA is pushing Congress to delay any pay cuts until Jan. 1, 2012, an action that also has the support of Department of Health and Human Services.
The uncertainty cast a cloud over Medicare's annual open enrollment period, which runs from November 15 to December 31. Wilson noted that "there is a growing concern that Medicare is becoming an unreliable payer."
Mara Mayor, a board member with the AARP, also weighed in. "Congress has a responsibility to keep doctors in the Medicare program," she said. "It's time for politicians to come together to stop these cuts so seniors can have the peace of mind they've earned."
Whether the new Congress has the political will to address the issue and remake the tattered reimbursement model or continue to apply band-aids as their predecessors have for the past eight years remains to be seen.