Are You Tired of Playing Kick the Can?

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We're coming up on yet another deadline for major Medicare payment cuts, a deadline that was delayed months ago by a Congress that chose to kick the can down the road, rather than do the heavy lifting and make the hard choices that a permanent solution would require. Will Congress yet again take the easy way out and avoid its responsibility to ensure that physicians receive equitable reimbursement and patients on Medicare continue to have access to services?

Stop me if you have heard this one before: We’re coming up on yet another deadline for major Medicare payment cuts, a deadline that was delayed months ago by a Congress that chose to kick the can down the road (again) and enact a temporary fix to the sustainable growth rate (SGR) formula, rather than do the heavy lifting and make the hard choices that a permanent solution would require.

Will Congress yet again take the easy way out and avoid its responsibility to ensure that physicians receive equitable reimbursement for their services, and patients on Medicare continue to have access to health care services? These delays and temporary “doc fixes” only serve to create an uncertain business and practice environment, making it difficult, if not impossible, for practices to make meaningful financial plans and budgets beyond the next arbitrary deadline.

This congressional inaction is having real repercussions for practices and patients across the country. Hospitals and practices are being forced to make the hard financial choices evaded by Congress and reevaluate the extent of their participation in Medicare.

A recent survey by the Medical Group Management Association revealed the extent to which the lack of a permanent fix to the SGR formula is hurting practices and patients. Covering more than 2,800 practices -- including independent medical practices, hospitals, integrated delivery systems, medical practices owned by hospitals, academic clinical science departments, and other organizations -- representing more than 63,000 physicians, the MGMA survey sought to determine the effect of the upcoming Medicare payment cuts on access to care and practices’ ability to conduct business and plan for the future.

Physicians were asked: “As a result of the uncertainty created by the June 1, 2010, Medicare Part B payment reduction of 21.3 percent, later reversed by Congress, which decisions did your practice implement in June?” In response, 12% said that they had stopped accepting new Medicare patients altogether; 45% said that they reduced the number of appointments for current or new Medicare patients; 32% of practices said they had reduced the number of administrative support staff; 27% reduced the number of clinical staff; and more than 45% of practices said they had reduced physician and/or staff salaries and benefits. More than one-third of practices said they had put off purchasing an electronic health records system or other health IT tools.

Physicians, staff, and patients are already feeling the effects of the delay to find a permanent fix to the SGR formula, and I’m afraid it’s only going to get worse. The MGMA survey revealed that the current cutbacks may only be the tip of the iceberg; more than two-thirds of survey respondents said they are considering further limits to the number of new Medicare patients they see, nearly half said they are thinking about refusing to accept any new Medicare patients, and almost 28% said they may stop seeing all Medicare patients. Large majorities are considering reducing support and/or clinical staff, delaying increases in physician and/or staff salaries and benefits, and delaying the purchase of new equipment.

I agree with MGMA President and CEO William F. Jessee, MD, who said, “The concrete actions already taken by medical groups as a result of the uncertainty created by congressional inaction have added significant barriers to quality care. Uncertainty about the future is creating an unsustainable environment for many who practice in areas with large Medicare populations.”

Faced with the looming threat of a 23% Medicare payment cut on Dec. 1, followed by an additional 6.5% reduction on Jan. 1, 2011, it seems that the best physicians can hope for right now is yet another extension by the current lame-duck Congress. Then it will be time once again for physicians and their professional societies to try and convince a new slate of legislators to put the can away once and for all and find a permanent solution to this problem.

Thank you for reading.

Mike Hennessy