Physicians would receive a 6.1% cut to their Medicare payments starting Jan. 1, 2011, under a proposed rule issued by the CMS. That reduction would be in addition to a projected 23.5% cut that is scheduled to take effect Dec. 1, provided that Congress doesn't act to change it. The proposed rule's creation follows a tumultuous debate on Capitol Hill over Medicare's sustainable growth-rate formula.
The SGR formula has called for payment cuts to doctors for years, with Congress stepping in intermittently to stop the reductions. The latest intervention came late in June, when the House approved legislation to replace a 21.2% Medicare physician pay cut with a 2.2% raise through November. The measure was swiftly signed into law.
If Congress doesn't act later this year, however, that 21.2% cut will reappear on Dec. 1, a CMS spokeswoman says. Taking into account the 2.2% increase physicians will receive through November, the net result will be more like a 23.5% cut, she says.
Combine the 2010 reduction with the 2011 projected cut, and physicians potentially face a nearly 30% SGR cut in January, Cecil Wilson, M.D., president of the American Medical Association, predicts. “We are very concerned about the impact the continuing uncertainty about payment rates and cash flow disruptions may have on physician practices and on beneficiary access to physicians' services,” says Jonathan Blum, deputy administrator and director of CMS' Center for Medicare. Although more than 97% of physicians have chosen to participate in Medicare for 2010, “We are hearing more stories of physicians limiting the number of beneficiaries they will see,” Blum says.
The proposed rule also seeks to implement an incentive payment for primary-care services as well as provisions in the new health reform law that would eliminate out-of-pocket costs for most preventive services. Comments on the proposed rule are due Aug. 24, with a final rule to be issued by Nov. 1.