Problems With Reducing Physician Medicare Payments
There has been a great deal of attention given to The Medicare Payment Advisory Commission’s (MedPAC) recommendation to be given to Congress at the end of October 2011 to repeal the sustainable growth rate formula (SGR). SGR establishes Medicare payments to physicians and if Congress does not adopt another payment plan or come up with an alternative before January 1, 2012, physicians face a 30% pay cut. (Healthcare Financial Management Association, MedPAC Votes to Repeal SGR Formula (Oct. 13, 2011)).
The congressional “super committee” challenged with reducing U.S. budget deficits, is considering a “doc fix” in its recommendations, which is due November 23rd. A major item is that the 10-year cost of fixing the SGR is in excess of $300 billion. The short-term band-aid solutions that prevented the pay cut in recent years is also adding to the federal deficit. (Donna Smith, U.S. Deficit Panel Weighs Medicare Doctor Payments, Reuters (Oct. 12, 2011)).
In addition to determining how to solve the payment conundrum, the Health and Human Services Office of the Inspector General is reviewing the impact of physicians opting out of Medicare. Physician acceptance of Medicare patients decreased 2.6% between 2005 and 2008, but 61% indicated they would consider leaving Medicare if payments were significantly reduced from current levels. (Charles Fiegl, OIG to Study Physicians Who Leave Medicare, www.ama-assn.org (Oct. 13, 2011) citing the June 27, 2011 Archives of Internal Medicine, archinte.ama-assn.org/cgi/content/extract/171/12/1117).
Considering the financial impact on providers, accurate clinical documentation should be at the top of their list of concerns.
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