If the US Congress does not act soon, Medicare, and thousands of US senior citizens, could be in deep and even lasting trouble. Lawmakers have until the end of the year to pass a temporary change to Medicare’s provider payment formula; if they fail to act, physicians face a 27 percent pay cut starting January 1, 2012. But many physicians, already weary of the program’s bureaucratic requirements and costs for enrolling and billing, are refusing to take on more Medicare patients and are even thinking of simply disenrolling from the program altogether.
Says Dr. Jane M. Orient, executive director of the Association of American Physicians and Surgeons, which has “historically been opposed” to Medicare:
“Disenrollment is a way to evict occupiers from doctors’ offices and the patient-physician relationship. Occupiers include bureaucrats, bounty-hunting auditors, federal prosecutors waiting for doctors to trip up on complex rules — and AMA [American Medical Association] officials and committees who make up complicated codes and dictate the ‘relative value’ of all covered services.”
Provided that Congress seems likely to pass a change in the fee schedule, the Centers for Medicare & Medicaid Services (CMS) can give Congress a little more time to take action on Medicare’s payment provider formula by holding physician payments for a brief period in the new year. However, this option comes with a number of caveats as it would mean that (1) doctors would not get paid at all and (2) CMS would have millions upon millions of claims to process. Former CMS Administrator Tom Scully, who carried out just such a procedure in 2003, says doing so will be “definitely a nightmare.”
If CMS decided instead to send out reduced claims, it would then have to double back and pay doctors the difference, assuming that Congress approves an increase retroactively. This scenario is actually an “even bigger nightmare,” says Scully. Doctors, from those in small practices with minimal office staff to those at huge medical centers, would have to recalculate every single bill and request that CMS pay the difference.
Physician groups had actually urged the deficit supercommittee to rewrite the payment formula “because it has created a backlog of cuts — always postponed by Congress — that would be devastating if they actually took effect.” The supercommittee’s failure to reach an agreement eliminated the prospects of a permanent fix and the House must now consider a two-year fix to the payment formula. But doing so comes with many strings attached as this temporary adjustment is
… part of the Republican leadership’s year-end payroll tax cut bill. But it’s funded in part by cuts to key programs in President Barack Obama’s health care law. And Senate Majority Leader Harry Reid (D-Nev.) has already declared the bill dead on arrival in the Senate, singling out riders that bring in side issues such as the stalled Keystone XL pipeline project.
Established in 1966 as one of President Lyndon Johnson’s Great Society reforms, Medicare was intended to protect senior systems from exorbitant hospital bills. The government initially enrolled physicians automatically, but the advantage this once provided — not having to follow up with patients to get payment — has dissipated. Doctors who do not want to participate in the Medicare system must opt out every two years. In 2010, Medicare spent $528 billion, a sum that is “expected to grow exponentially as more baby boomers move into their golden years.” Even if Congress does pass the temporary “doc fix” this year to ensure that physicians don’t receive a deep pay cut, we’re still very far away from a long-term fix to Medicare.
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