Medicare Limbo Leaving Docs in Tough Position

The good news is you are getting a 2.2 percent Medicare payment update for six months and may not have to deal fully with a proposed 21 percent cut until the end of November. The bad news is, however, you will get temporarily shortchanged on June claims with the hope Congress reaches a consensus on reimbursements.

That is essentially the position the U.S. Senate put doctors in last week with its approval of their “doc fix,” reversing the 21% cut and providing a 2.2 percent Medicare physician payment update. The move still requires the approval of the House of Representatives to become a reality, but it does not reconvene until tomorrow.

In the meantime, CMS says it will begin to process claims dating back to June 1 it previously held while awaiting congressional action, resulting in docs receiving lower payments for those claims and having to plan accordingly. In a statement, CMS said it is “hopeful” Congress takes action to avert the negative update and “is prepared to act expeditiously to make the appropriate changes to Medicare claims processing” should both the Senate and House agree to defer the 21 percent cut until later this year.

So physicians entering their practice this morning are faced with two uncertainties: How long will I go without the full Medicare reimbursement and when will Congress make a long-term decision on whether or not to enact the proposed cut?

J. Fred Ralston, MD, the president of the American College of Physicians, said it is the latter uncertainty that is of more concern to the group’s membership of internists.

Ralston, a practicing physician in Fayetteville, Tenn., says in the past, Congress has played “a game of chicken” with the reimbursement cut deadline, but now, has let it pass, leaving docs unsure of where they stand on the issue.

“It is the uncertainty that Congress let this play out this much that is of greater concern,” he told Physicians Practice. “There is the concern that Congress doesn’t understand how important this is. Before, [getting to the deadline] was an annual event and we knew people were covered and, ultimately, it would all be worked out. Now, there is more uncertainty and that is a real frustration.”

Ralston said physicians now need to take a “leap of faith” with their financial planning, insecure in the knowledge that Medicare reimbursements will return to previous rates. If you can’t count on that part of payment, he said, that leaves physicians pondering the future of Medicare patients.

A series of recent research supports the trend of doctors refusing new Medicare patient due to low government payment rates, and Ralston said ACP members are trying to decide the future of their practice in terms of limiting or even eliminating Medicare patients.

A sense of frustration, Ralston said, is putting physicians in the difficult position of trying to predict their financial futures amid the uncertainty of Medicare reimbursements.
“It is hard to end a relationship with a patient…but if someone is very busy, they may choose to broaden the range of patients they see in their office as you may move towards those whose payment you can count on,” he said.