Cath Lab Digest

Lawmakers Continue to Struggle with Doc Fix

Temporarily delaying mandated reimbursement cuts for physicians providing Medicare services has become a routine and recurring event in the US Congress. Since 2002, lawmakers have repeatedly passed legislative stopgaps to forestall reductions in the Medicare Physician Fee Schedule (MPFS) mandated by Medicare’s Sustainable Growth Rate (SGR) formula, but some of the recently enacted pay patches have lasted little more than a month. While lawmakers procrastinate, frustrated doctors continue to advocate a permanent solution, often called the doc fix, which would repeal Medicare’s SGR formula and fix physician payments at stable or increasing rates.

Despite the comprehensive nature of recently enacted national healthcare reforms, changes to Medicare’s SGR formula did not make it into the final legislation. Instead, a 21.2% rate cut scheduled to go into effect for services paid under the MPFS on or after January 1, 2010, was replaced with a zero percent update until March 1 by a provision in the Defense Appropriations Act of 2009, and again until April 1 by the Temporary Extension Act of 2010.

The Medicare physician payment cuts were previously delayed 7 other times over the last 7 years. Scheduled cuts of 4.4% in 2003 and 4.5% in 2004 were replaced with increases of 1.6% and 1.5%, respectively. In 2009, a scheduled 10.1% cut was replaced by a 6-month, 0.5% raise followed by an 18-month freeze. And in 2009 a scheduled 15% cut was replaced with a 1.1% rate increase.

At press time the most recent legislative reprieve for Medicare physicians was included in the Continuing Extension Act of 2010, which extended the zero percent MPFS rate update through May 31, 2010. Because the Continuing Extension Act was not enacted until April 15, 2 weeks after the previous extension had expired, the zero percent update was made retroactive to April 1; it was the second retroactive pay patch this year.

The Continuing Extension Act of 2010 also extended Consolidated Omnibus Budget Reconciliation Act health insurance subsidies, unemployment benefits, national flood insurance, and other expiring programs. In the statement released by the White House on passage of the bill, President Obama did not comment on the temporary postponement of Medicare pay cuts or proposals for a permanent solution.

After enactment of the Continuing Extension Act, the Centers for Medicare & Medicaid Services (CMS instructed Medicare contractors to begin processing claims under the new law for services provided by physicians, nonphysician practitioners, and others paid under the MPFS. Medicare held most claims with dates of service April 1 and later in anticipation of congressional action. If Congress had not acted, payment rates for these services by physicians, nonphysician practitioners, and others who are paid under the MPFS would have been reduced.

“The administration has repeatedly stated that the formula that determines what physicians and others are paid under the MPFS is broken and needs to be fixed. We will continue to work with Congress to find a long-term solution,” said Jonathan Blum, deputy administrator and director for CMS.

On April 12, AARP CEO A. Barry Rand sent a letter to every senator, urging them to rescind the 21% cut to Medicare’s reimbursement. In the letter, Mr. Rand told senators that “without prompt congressional action, Medicare beneficiaries are at risk of not getting the timely physician care they need to stay healthy and avoid more costly institutional care.”

The American Medical Association (AMA) has also called for an end to the cycle of delays and retroactive pay patches. AMA asserts that the longer Congress waits, the more expensive a solution will be and the more physicians will elect to limit the number of Medicare patients they see or stop treating them altogether.