Docs Worried as Payment Cut Deadline Nears

Despite a stepped-up lobbying effort over the past months, leading physicians' groups appear resigned and exasperated with the idea that Congress will not take permanent action to fix the sustainable growth rate formula before 21% reimbursement cuts for Medicare take effect March 1.

While all but surrendering hope for a permanent solution to end the annual "doc fix" on Capitol Hill, physicians now wonder if an 11th hour temporary fix is doable.

"I don't see the vehicle that Congress can use to come up with that short-term fix," says Lori Heim, MD, president of the American Academy of Family Physicians. If the cuts are to be averted, at least temporarily, Heim says, CMS may have to step in.

"CMS can hold up payments for 15 days, which means that a cut won't go into place, but payments won't go out," she says. "Or CMS could keep paying on time, there will be a cut, but CMS will look to Congress to do a retroactive increase. Those are still two possibilities.

"Either way, physicians are going to start feeling the pinch right away. When your payments are delayed two weeks that means that predicting what your income is going to be starts getting up close and personal."

Cecil Wilson, MD, president-elect of AMA, says, "There is no clue out there [as to] what Congress' intent is. It's a mystery. From our perspective, Congress is diddling with partisan politics while letting Rome burn and not protecting access to care for seniors and the families of our military, all of whom depend upon Medicare and TRICARE."

"The later it gets, the closer it gets to the witching hour, the more concern we have. The thing to be done is to try to shame them into stepping up to the plate and assuming their responsibilities for seniors, military families, baby boomers who are going to be entering Medicare in 2011, when the first wave starts," Wilson says.

In 1997, Congress mandated Medicare spending cuts that were scheduled to begin in 2001. Those cuts have never taken effect, because each year AMA and other healthcare lobbying groups push Congress to delay the cuts. Each annual Band-Aid fix, however, makes the next year's cuts deeper. The latest 21% cuts were to have taken effect on Jan. 1, but Congress pushed the deadline back to March 1.

"There was some hope that during that 60-day window they would get a healthcare reform package done that would also pave the way to do an SGR permanent fix," Heim says. "Part of the problem is now there is still a desire to get healthcare reform done, but it is hitting more obstacles than many people anticipated, and the SGR has been captive to that whole process."

In October, AMA lobbied unsuccessfully for a bill that would have reset the sustainable growth rate formula for physicians back to zero to eliminate around $245 billion debt that has accumulated during the past six years as a result of Congress' annual fixes. The bill mustered only 47 of the 60 votes needed to bring it to the Senate floor. Now, the SRG fix could get even more difficult because of the election year concern in Washington over red ink. Republicans have made the $12.4 trillion national debt, and the $1.4 trillion federal budget deficit key issues against Democrats.

Despite the cloudy budget picture, Wilson says AMA remains insistent upon a permanent fix to the problem, and not another "kick-the-can" deadline extension. He concedes, however, that a temporary fix is more likely with the looming deadline.

"Obviously, the later you get the more likely you fear that that is what Congress will do. What we are saying is that is unacceptable," he says. "A year and a half ago, we provided support for another temporary fix with the commitment from Congress in both houses on both sides of the aisle that in the coming 18 months they would have plenty of time to decide how to fix the problem permanently and get us out of this situation. They have frittered away that opportunity and now they are in the same position they have been in on an annual basis ever since 2001."

"Congress somehow finds a way to do things that they feel are important. When they feel there is urgency about something, they find a way to do it," he says. Heim says AAFP "has pretty much exhausted most of the ideas of our members." At this point, she says, family physicians are being asked to contact their respective members of Congress with a personal plea to address SGR.

"There is some physician fatigue going on here," Heim says. "I'm having more physicians this year than ever before tell me 'I just don't think Congress gets it and I am tired of doing the last-minute fix.'"