April Fool's Day: Congress Delays Doctor Medicare Pay - Again!

Each year for the last 10 years, Congress’s Sustainable Growth Rate (SGR) formula calls for a cut in doctors’ Medicare pay.

Each year, Congress backs off, and gives the doctors a tiny increase in pay, for fear doctors will stop seeing Medicare patients.

Each year, doctors and medical societies plead for Congress to drop the SRG formula.

This year the SGR called for a 21% cut on April 1. So what did Congress do? It left for its Easter recess without voting to delay the scheduled April 1 start of lower payments to doctors. Medicare delayed the cuts by deciding not to pay claims for the first 10 business days in April. When Congress returns on April 12, it’s still expected to adopt another law to delay the cuts for longer, as it has done annually for ten years now.

Who is the April Fool here? Congress? It toys with physician reimbursement, further antagonizing doctors, and potentially driving them away from seeing new Medicare patients. Doctors? They tolerate this annual SGR game, and continue to see Medicare patients at rates that often do not cover office expenses.

According to the WSJ health blog, The long-standing threat of Medicare cuts is weighing on doctors, say medical societies.

“It’s tough,” Andrew LaMar, spokesman for the California Medical Association, told the Health Blog. “Imagine if every month you didn’t know what your paycheck is going to be.”

David Kloth, past president of the American Society of Interventional Pain Physicians, told the WSJ Health Blog that private insurers base their rates on those set by Medicare, so a cut in Medicare payments would likely result in reimbursement cuts across the board. And if their revenue drops significantly, doctors either may have to stop seeing Medicare patients or lay off employees, he says. “If they’re not careful, they’re going to drive doctors out of Medicare and Medicaid,” says Kloth.

The WSJ Health Blog, perhaps the most read health-related blog of them all, asked for comments on the SGR situation.

Here was my comment,

“It boils down to this. universal coverage without doctor access is meaningless. As I write, 50% of doctors do not accept Medicaid patients, and under the new law, 16 million more will join the Medicaid ranks. Furthermore, 30% of doctors do not accept new Medicare patients. In 2011, 78 million baby boomers, or 12,000 each day, will start flooding into Medicare. Who is going to take care of these folks? There is already a shortage of doctors in the 50,000 range, and that will grow to 150,000 within 10 years.

A political crisis will soon be at hand, I write about this doomsday scenario in my book Obama, Doctors, and Health Reform in my blog medinnovation. It could be averted by Obama and Congress must act soon.”

For you doctors under the Congressional SRG gun, Happy Easter! May the Federal Easter Bunny bring you tidings of small joy.