Medicare payments to doctors cut 21 percent Monday unless Congress acts

The payment cut likewise applies to members of the military on the federal government’s TRICARE insurance.

Physicians have been on pins and needles for sometime over the Medicare payment cut and they didn’t expect it would go through because of extensive lobbying and historically, Congress has reversed the cut in prior years.

“This weekend you will see a lot of them sweating,” said Dr. Joseph Gauta, president of the Collier County Medical Society. “Nobody thought this would take effect. They thought it would be fixed.”

A reimbursement cut, of a varying amount, from Medicare is expected annually with the start of the new fiscal year on Jan. 1 but Congress usually acts in time to reverse it. In the final days of the session last year, Congress only postponed the 21-percent cut for this year to March 1.

At issue is what physicians and the American Medical Association (AMA) say is a flawed formula, called the sustainable growth rate, that sets an annual target for Medicare spending on physician services.

Some local physicians whose practices are largely Medicare patients, such as geriatricians, and cardiologists who faced a separate reimbursement cut earlier from Medicare, will be particularly hard-pressed to cope, Gauta said.

The American College of Cardiology filed a lawsuit last year against the federal government for reductions in Medicare this year for certain cardiology services. For instance, cardiologists are seeing a 36-percent payment cut for nuclear stress tests.

After the Senate Friday failed to act and delay again the overall physician cut, which the House did on Thursday, the Centers for Medicare and Medicaid, CMS, notified contractors to hold off processing Medicare claims from physicians for 10 days.

The move to sit on the claims is similar to action taken in 2008 when the Medicare cut of 10.6 percent that year went into effect before Congress later froze it. The pending claims then did not have to reflect the 10.6 percent cut.

“It’s just delays all over again, this year much later than in other years,” said Margaret Eadington, president of the Collier medical society. “The only solution is to fix the system.”

Gauta said patients likely aren’t aware of what is going on for their physicians, in part because they are focused on the overall health care reform debate, and the same goes for members of Congress.

“This has been a total nothing,” he said, referring to the Medicare cut.

Unless Congress reverses the 21-percent payment reduction in the near future, some physicians may reduce the number of Medicare patients they see or opt out of Medicare entirely. A third option is accepting Medicare patients but not participating in the Medicare program, he said. In that case, the physician bills the patients but not more than 15 percent above what they would get from Medicare, he said.

If a physician decides to opt out of Medicare entirely, the physician can charge what he or she wants and the Medicare patient pays the doctor and seeks to be reimbursed from Medicare, Gauta said.

The AMA on Friday issued a terse statement calling on the Senate to stop playing games with physicians and seniors. The House had passed legislation that would have repealed the funding formula.

“The Senate had more than a year to repeal the formula and ensure the security and stability of Medicare and TRICARE, but that opportunity has been squandered,” said Dr. James Rohack, the AMA president. “This drastic cut will hurt our senior, disabled and military patients, as well as baby boomers who start entering the Medicare program next year.”

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