I read an article a few weeks ago and have kind of been waiting to see how things played out. This might not be an interesting read for most, but it caught my interest so I'm passing it along with minimal comments of my own. Note that this is not meant to be political, but informative. Online sources: here, here and here.
Medicare uses a formula called the Sustainable Growth Rate (SGR) formula to calculate what physicians should be making for specific services (for Medicare patients). There is a supposed "widespread agreement" that the formula is "fatally flawed". As Medicare repeatedly reruns this formula, the results are the same; cut the payments to the physicians. Congress, in the past, has stepped in and prevented these pay-cuts from proceeding. The latest proposed pay-cut was supposed to be a 21.2% pay decrease to physicians and was supposed to take effect April 1st. On April 19th, the Senate voted to push out the start date from April 1st to June 1st, with plans to potentially extend the current payment plan into October.
"So what? How will this affect me?" you ask.
An online survey conducted by the Surgical Coalition, which represents 240,000 surgeons and anesthesiologists, received feedback from nearly 14,000 physicians. These are doctors from various specialty areas, including: Anesthesiology, Cardio-Thoracic Surgery, Colon and Rectal Surgery, Facial Plastic and Reconstructive Surgery, General Surgery, Neurosurgery, OB-GYN, Ophthalmology, Oral and Maxillofacial Surgery, Orthopaedic Surgery, Otolaryngology – Head and Neck Surgery, Pediatric Surgery, Plastic Surgery, Urology, and Vascular Surgery.
A majority of the respondents claim that they "will be forced to make significant changes in their practices if the cut goes into effect and that timely access to surgical care will be jeopardized if Medicare payments continue to decline." The survey revealed that 96% of those who responded currently participate as Medicare practitioners. If this cut goes into effect, less than one third of them will "be able to remain as Medicare participating physicians."
When asked, "If Medicare reimbursement to physicians is cut by over 21%, what changes to your Medicare participation status do you plan to make?" Respondents answered:
- 37 percent will change their status to nonparticipating
- 31 percent plan on remaining a Medicare participating physician
- 29 percent will opt out of Medicare for two years and privately contract with Medicare patients
- 3 percent will remain a Medicare nonparticipating physician (this is the portion who were currently NOT participating – in other words, they would not change their status to "Participating")
I kind of like numbers, and these numbers are pretty easy to follow. Of the 14,000 who responded, approximately 13,580 currently participate in Medicare. 420 physicians who responded do not participate in Medicare. If the pay-cut goes into effect, 66% of the current participators will opt out or completely drop being a Medicare participator for a minimum of two years. This is an additional 8,960 physicians on top of the 420 physicians who already do not participate in Medicare, for a total of 9,380. This leaves approximately 4,600 physicians out of 14,000 that will participate in Medicare. Of the 31% of physicians who will still be Medicare participants, three-fourths say they will have to make changes in their practices over the next 12 months, such as "stop providing certain services, reduce staff, defer purchase of new medical equipment, and/or reduce time spent with Medicare patients." Keep in mind, this may be your doctor or specialist.
Below are a few quotes from online commenter's as well as respondents from the survey (they will be pasted in verbatim, so typos belong to the responders). Consider that some of these comments may be wild threats made by greedy doctors who only care about the "bottom line" (aka, their pocket-books). If these are greedy doctors using strong-arm tactics to sway the mind of Congress, it may be working. On the other hand, they may be compassionate practitioners in your town who do care about the patient and the well-being of the community, but truly can't afford to continue treating people at their own expense. We may never know which is which.
charles dupin
Mar 29, 2010
Currently my practice has about a 65% overhead. We therefore are making 35% profit in our relatively small practice. A 20% cut in medicare riembursement would reduce our profit to 15% (working for tips). If other carriers follow medicare, we will not be able to sustain our practice.
Barron O'Neal, MD
Mar 29, 2010
I provide many services at "break even" cost. I will discontinue those servises if the cost of providing those services is more than the reimbursement. Giving care away is one thing. Having to pay to give care away is too much. Barron O'Neal, MD
"I will elect not to perform complex surgery/high‐risk surgery unless it
is emergent and I will decrease elective cases."
General Surgeon
"I am in an academic facility. This could have a devastating impact on
the institution as a whole. The system is already financially strapped.
We are working at close to the breaking point in terms of providers
and resources."
Urologist
"I work in rural area and this will force me to close; the recession has
already put me on the edge with a 10% drop in revenue. Then there
will be no one serving this community's poor."
Orthopaedic Surgeon
"I will no longer be able to afford to do charity cases and will quit
doing them. I am the only cataract surgeon in the area who does
these cases."
Cataract Surgeon
"This will result in staff getting let go without much delay, and the
remaining will work harder."
Ophthalmologist
"This cut will result in longer waits as we cut back clinics due to lack of
staff, longer time to next available appointments and many patients
being turned away at the door. In addition this will negatively affect
the pipeline for people going in to surgery."
General Surgeon
"Medicare patients will essentially be standby only if I have no other
patients to see."
Orthopaedic Surgeon
