Healthcare Business News
Susan Turney, president and CEO of MGMA-ACMPE

Doc associations rip Medicare pay deal

By Jessica Zigmond
Posted: February 15, 2012 - 3:00 pm ET

(This article has been updated with a correction.)

Physician associations denounced Congress for failing to find a permanent solution to Medicare's sustainable growth-rate formula after lawmakers reached a tentative agreement that would force them to revisit the issue at the end of the year.

The deal would avert a 27.4% Medicare payment cut to physicians after Feb. 29 and extend current payment rates through the end of 2012, according to a GOP aide.

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“We are deeply disappointed that Congress has missed a unique opportunity to repeal the SGR once and for all and instead has chosen political expediency over patients,” Dr. Susan Turney, president and CEO of MGMA-ACMPE, formerly the Medical Group Management Association, said in a statement.

“Physician practices now face a mounting 35% payment threat from Medicare in 2013 and Congress has dug itself a $400 billion hole,” Turney's statement continued. “Group practices are telling us that this congressional decision exacerbates an already unhealthy environment that limits their ability to plan for the future and balance their practice's fiscal health with their desire to continue to serve Medicare beneficiaries.”

The deal also would extend certain Medicare programs—namely, ambulance add-on payments and outpatient hospital hold-harmless payments—but requires that the CMS, Government Accountability Office and Medicare Payment Advisory Commission report to Congress on the effectiveness of those programs. And two Medicare programs—Section 508 hospitals and special pathology payments—would be phased-out while providing time for providers to adapt. The agreement would also call for extending and reforming the therapy cap exception process by requiring greater accountability.

Meanwhile, about $11.6 billion in cuts to the Patient Protection and Affordable Care Act—including more than $4 billion in Medicaid spending reductions—would pay for more than half of the Medicare spending in the agreement.The healthcare savings that don't come from the Affordable Care Act total $9.6 billion and include reductions to Medicare bad debt and clinical laboratory payments.

“The House and Senate conference committee agreement averts a 27% cut on March 1, but it represents a serious missed opportunity to permanently replace the flawed Medicare physician payment formula and protect access to care for military families and seniors,” Dr. Peter Carmel, president of the American Medical Association, said in a statement. “People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion.”

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