CMS proposes additional 6.1 percent cut, invites nonparticipating physicians to jump in

On June 25, President Obama signed the long-awaited, severely whittled temporary SGR reprieve into law. Retroactive to June 1, physicians will receive a 2.2 percent increase in Medicare reimbursements--until the bill expires on Nov. 30. Barring a long-term fix in the meantime, physicians who accept Medicare will then face the delayed 21.3 percent cut plus the elimination of the 2.2 percent bump, culminating into a 23.5 percent decrease on Dec. 1.

Predictably, physicians' concerns are not allayed by legislators' short-term solution. David A. Cook, executive director of the Medical Association of Georgia, summed up the problem in a USA Today letter to editor: "Congress has repeatedly failed to take the action needed to address Medicare funding. It is true that lawmakers passed yet another temporary Medicare patch late last week, keeping in mind they let a draconian, 21 percent cut in physician payment go into effect June 1. But that's nothing more than a condescending act of political illusion, as that cut will be reinstated in December."

In addition to the projected 23.5 percent reduction, deeper cuts are possible still, as the Centers for Medicare & Medicaid Services has issued a proposed rule that would implement provisions in the Patient Protection and Affordable Care Act of 2010 that reduce preventive services for Medicare beneficiaries by another 6.1 percent on or after Jan. 1, 2011.

According to CMS, the proposed rule, on which it is accepting comments until Aug. 24, would implement provisions in the PPACA that would seek to "eliminate out-of- pocket costs for beneficiaries for most preventive services, including the new annual wellness visit." Meanwhile, the rule would update other policies and payment rates for services by physicians, nonphysician practitioners and certain other suppliers that are paid under the Medicare physician fee schedule during 2011, reports CMIO.

"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," said Jonathan Blum, deputy administrator and director of CMS's Center for Medicare.

Indeed, as more physicians decide to opt out of Medicare fearing continued cuts, CMS announced on June 28 that it would extend the deadline for nonparticipating physicians to change their status to participate in Medicare until July 16.

According to the agency, "any new CMS-460 form received during this limited enrollment period will be retroactive for claims with dates of service of Jan. 1, 2010, and later." However, the change in participation status will only apply to new claims submitted after the physician's new status as a participating physician is processed. "Claims previously submitted and processed will not be adjusted for only a change in participation status," CMS said.

To learn more:
- see this piece in MedPage Today
- read the USA Today letter to the editor
- check out this CMIO article
- get this update from the American Academy of Family Physicians

Related Articles:
As Medicare fight rages, study shows cutting reimbursement may backfire
One step forward, two steps back for doc fix--again
Congress approves temporary doc fix measure; AMA still unhappy