Ongoing Medicare physician payment dilemma

'Uncertainty creates total chaos for patients and physicians,' says ACP president, a practicing Georgia internist

"Because of Congress's inability to find answers to the ongoing Medicare physician payment dilemma, physicians across the country are unable to accept and treat new Medicare patients," Joseph W. Stubbs, MD, FACP, president of the American College of Physicians (ACP) declared today as he considered the impending effects of the cut to the Sustainable Growth Rate (SGR). "This is simply because the uncertainty creates total chaos from a business-planning perspective."

The 21 percent physician payment cut - that was originally scheduled to take effect on Jan. 1 - is set instead to begin on April 15. Twice before, at least month-long reprieves have staved off cuts before they could take effect. While Congress continues to work toward a further delay of the cuts, lawmakers have yet to agree on a pathway.

The Centers for Medicare and Medicaid Services (CMS) instructed its contracted-insurance companies to place a 10-day processing hold on claims for services provided on, or after, April 1. The "hold," CMS said, was to minimize administrative complications and other disruptions that would result from calculating payments that reflect a rate reduction that Congress is expected to overturn. By existing law, that 10-day hold period ends on Wednesday, April 14.

" If Medicare begins paying physician claims with the 21 percent reduction starting on April 15, any short-term fix that might be legislated this weekend or later - even though retroactive - likely will create a cash-flow problem in the meantime with claims being paid at the lower rate," Dr. Stubbs noted. "This will send an unfortunate message to Medicare beneficiaries.

In addition to his ACP presidency, Dr. Stubbs is a practicing internist in a small practice in Albany, Ga. His perspective for his comments comes from his travels throughout the country and his more than 30 years of practice.

"There's the additional wrinkle that doctors may have to go back and re-bill patients for higher co-insurance once the payments are restored retroactively," Dr. Stubbs concluded. "If Congress then applies some short-term fix - be it for six weeks or six months - the added cost of rebilling will just add to the chaos."

Again repeating the sentiments of a multi-year ACP crusade, Dr. Stubbs said: "The only effective answer for patients and physicians, who operate small businesses, is a long-term solution to physician payments that provides predictable, positive and stable updates that keep pace with practice costs."