The House passed a bill last Thursday to delay the pay cut for 30 days, and the Senate may take up a similar bill on Tuesday. But the AMA is insisting that Congress needs to change the formula behind the fee cut rather than add another patch, as it has done each year for nine years.
Scott Becker, JD, CPA, says the fee cut would have different consequences for each specialty and they could be significant:
1. Specialties that treat a high percentage of Medicare patients — such as ophthalmology, gastroenterology and cardiology — would not be able to avoid a direct financial loss.
2. Specialties that are less dependent on Medicare may be forced to allocate less time to Medicare patients and some specialists may be able to focus more time on better-paying commercial patients. This consequence is one that has been advanced, particularly, by the AMA.
3. Physicians, even those who disdain healthcare reform, may feel under pressure to accept healthcare reform in exchange for a payment fix. The AMA, for example, endorsed President Obama’s healthcare reform efforts in return for possible reimbursement help on the Medicare side. However, this help is unlikely to benefit physicians in the long run. (Editor’s Note: See “3 Things Wrong With the AMA’s Support of the President’s Healthcare Reform Plan” by Scott Becker.)
Even if the Senate manages to pass a one-month patch this week, Congress would have to decide on a longer-term solution. The AMA reiterated its demand for a permanent change in the formula behind the fee cut, rather than stave off the cut and allow it to keep growing beyond its already very dangerous level of 21.2 percent.
“The AMA will not accept a temporary patch,” AMA President J. James Rohack, MD, wrote in his blog last Friday. “It’s only making a festering boil worse. This needs to be lanced once and for all to allow the pus that has grown due to multiple temporary Band-Aids to finally be drained so the healing can occur.”
The AMA warned that the cut would prompt physicians to reduce the number of Medicare patients they treat and even prompt some to change their status to non-participating. The organization pointed to a recent survey of neurosurgeons finding that if the cuts took effect, 40 percent of them would decrease the number of new Medicare patients they treat and more than 18 percent would no longer take new Medicare patients. The survey also found that 60 percent of the neurosurgeons had already reduced the number of Medicare patients they treat.
CMS says physicians who want to change their Medicare status must do so by March 17. Changing their status to nonparticipating would reduce their Medicare payments but would allow them to bill patients extra.
To change status, physicians must complete a CMS-460 form, available through Medicare contractors, and sent it to their local contractor with a postmark of no later than March 17, according to the American Association of Family Physicians.
CMS sent physicians a guidance last week announcing the temporary hold on claims. “We believe Congress is working to avoid the negative update that will take effect March 1, 2010,” the guidance said. “Consequently, CMS has instructed its contractors to hold claims containing services paid under the [Medicare Physician Fee Schedule] for the first 10 business days of March.… This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days after the date of receipt.”
Read the AAFP release on the Medicare physician fee cut.
Read the AMA release on the Medicare physician fee cut.
Read AMA President Dr. Rohack’s blog posting.
See previous coverage from Becker’s ASC Review on the physician fee cut:
Feb. 24, 2010: With Fee Cut Looming, AMA Shows How to Become Medicare Non-Participant
Feb. 12, 2010: Physician Fee Fix, Other Health-Related Items Removed From Senate Jobs Bill.
Feb. 3, 2010: Five Year Fix for Medicare Doctor Pay Cuts in Works
