Medicare's 5.4% decrease in 2002 physician payments continues to be a hot topic of discussion in Washington.
Yet, as leaders of physician groups and government agencies testify before Congress, the timeline for any resolution remains unclear.
The problem is money. The Congressional Budget Office places a price tag of $126 billion over a 10-year period on the recommendations given by the Medicare Payment Advisory Commission, an independent federal body that advises Congress on issues affecting the Medicare program.
"It's like getting sticker shock," says Richard Trachtman, director of congressional affairs for the American College of Physicians and the American Society of Internal Medicine.
"Still, we don't believe it'll cost that much."
ACP/ASIM plans to work with other physician groups on an independent analysis of the cost to fix the physician payment problem.
MedPAC's March 2002 report to Congress recommends repealing the current sustainable growth rate formula, which ties physician payments to the overall economy, and implementing updates based on changes in costs and productivity.
MedPAC also recommends that Congress increase payments for physician services by 2.5% for 2003.
MedPAC for the past year has stressed to Congress the problem of the current formula, which causes large year-to-year swings in payment updates that are unrelated to changes in the cost of providing physician services.
This is reflected in the 5.4% and 4.5% payment increases in 2000 and 2001, respectively, and the 5.4% drop this year, MedPAC's chair Glenn Hackbarth testified at a Feb. 28 congressional hearing.
Projections using the current formula indicate three more years of declines for physician update payments, for a total decrease of about 17% through 2005.
Not changing the current system will aggravate current problems consumers experience, such as difficulty in finding doctors who accept Medicare and long waits for appointments, said Paul Ginsburg, president of the Center for Studying Health System Change, at the Feb. 28 hearing.
Physician practices are already seriously threatened by the current payment cut, especially since two-thirds of practices are considered small businesses, says AMA Secretary-Treasurer Donald Palmisano, M.D.
The reductions leave physicians with such alternatives as not accepting new Medicare patients, opting out of the Medicare program, laying off administrative staff and retiring early or changing careers, Palmisano says.
Regardless of the gravity of the situation, no one is stepping up quickly to resolve the problem.
Indeed, President Bush did not earmark any money to address the issue when he proposed his recommended 2003 budget in February.
Trachtman says, "Any solution has to be budget-neutral, which means that now the money must be found by reducing payments to others under the Medicare program and applying that money to fix the physician payment problem. That's not an ideal situation for anyone."
While it is possible Congress could agree on a budget resolution that sets aside funding to fix the problem, that also will take time.
Over the next two months, Congress will tinker with the 2003 budget to meet its April 15 deadline.
"Yet Congress frequently fails to meet that deadline, and with a Democratic Senate and a Republican House, that doesn't auger well for an agreement," says Trachtman.
And according to Kevin Hayes, MedPAC's research director for Part B services, physicians shouldn't bank on receiving retroactive payments for 2002.
"Conversationally, no one has seriously discussed retroactive reimbursements to physicians for services billed for this year," says Hayes.
"The most that could happen is some type of elimination of the (5.4%) payment cut for the rest of the year."
When that "rest of the year" will begin remains the big question.
In the meantime, congressional leaders are working to draft comprehensive Medicare reform legislation.
That effort most likely will include physician payment issues as well as prescription drug coverage.
The latter is another issue begging financial attention, and it is one that draws skepticism.
"Even if Congress could agree on the price tag for a prescription drug package--a big if--we still need to resolve delivery system issues," says Sen. John Breaux (D-La.), a member of the Senate Finance Committee.
Those issues are complicated and generate "deeply held differences of opinion" among some members, he says.
"I am an eternal optimist, but the chances of passing prescription drug legislation this year are less than 50-50," Breaux says.
"I hope I'm wrong, and I'll try to prove I'm wrong."