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VOL. 125 | NO. 18 | Thursday, January 28, 2010

Cuts on Track For Medicare Doctors

By Tom Wilemon

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While Congress tries to decide what to do about health care reform, the clock is ticking for severe cutbacks in Medicare reimbursements to doctors.

The 21.5 percent cutback, which is scheduled to go into effect March 1, affects Medicare, the federal insurance program for the elderly and the disabled, as well as Tricare, which provides coverage to Americans serving in the armed forces and to military retirees.

“We’ve got a real crisis that’s looming,” said Dr. Wiley T. Robinson, a Memphis internist who serves as speaker of the House of Delegates for the Tennessee Medical Association.

The cutbacks are required by the Balanced Budget Act of 1997, which sets a sustainable growth-rate formula for setting physician reimbursements.

Doctors and health care experts have long complained the SGR formula is flawed, and each year Congress grants a reprieve on scheduled cutbacks. The difference this year is the reprieve got tied up in the massive health care overhaul.

No more kicking the can

That legislation ground to a halt in the political fallout after the election of a Republican to theU.S. Senate seat formerly held by Ted Kennedy, which ended the Democrats’ filibuster-proof majority.

With President Obama now shifting gears to focus more on job creation and deficit reduction, the outcome of health care legislation is uncertain. Action on the SGR formula, commonly referred to as the “doc fix,” remains unfinished business.

“It got lost a little bit in the shuffle for health system reform,” said Don Alexander, chief executive officer of the Tennessee Medical Association. “We are trying to meet now with our senators to say this is something that has to be fixed regardless of what you do about health system reform. You have promised to fix it for 10 years and haven’t. We no longer will accept roll-forwards from year-to-year.”

The annual reprieves do not correct the formula nor end the uncertainty that underlies the shortage of primary care physicians, Robinson said. Medical students opt to become specialists because primary care practices depend heavily on Medicare reimbursements.

Doctors have already begun not accepting Medicare, he said.

Exasperation point

As the Baby Boom generation continues to age, a larger percentage of Americans will depend on Medicare for their health care coverage. The American Association of Retired People and the American Medical Association have begun efforts to raise awareness about the scheduled cutbacks.

Dave Kendall, a senior fellow for health policy at Third Way, an organization that bills itself as the “leading moderate think-tank of the progressive movement,” has been keeping a close watch on Congress.

Kendall said he believes there will be some movement on health care reform after the president’s State of the Union address Wednesday night.

“For SGR that means it’s still very much a possibility that can get fixed in the way that doctors have asked for it to be fixed,” Kendall said. “If health care (reform) doesn’t happen, I think there would still be a fix, but it would be much more short term.”

However, doctors are tired of temporary reprieves.

“This was to be in effect Dec. 31, then they moved it two months this time,” Alexander said. “They will get to the end of the year and they will kick the can another couple of months. Yes, it’s been this close before, but it’s never been kind of swallowed up in the health system reform debate before.”

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