As of press time, the doc fix remains an enigma. Although the Senate passed a six-month patch late last week, Speaker of the House Nancy Pelosi (D-Calif.) is reportedly holding out over anger toward Senate Majority Leader Harry Reid (D-Nev.) for separating the Medicare issue from the rest of the jobs and economics legislation without notice, reports Politico.

"The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs," Pelosi said in a statement. "I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate."

Meanwhile, CMS this week began processing claims reflecting the 21.3 percent cut. For a typical office visit, that translates to about $8 less than a physician would have received from Medicare in 2007. Although all claims will be automatically reprocessed to retroactively reimburse providers the difference when and if a doc fix goes through, CMS estimates each claim to be reprocessed will cost the agency 30 cents, which could add up to $15 million for the first 50 million claims held since June 1 alone.

Not surprisingly, physicians are losing hope. USA Today has pulled together some numbers, and they're not looking good for Medicare beneficiaries, especially those who might seek a new doctor:

• The American Academy of Family Physicians says 13 percent of respondents didn't participate in Medicare last year, up from 8 percent in 2008 and 6 percent in 2004.
• The American Osteopathic Association says 15 percent of its members don't participate in Medicare and 19 percent don't accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.
• The American Medical Association says 17 percent of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31 percent.

As the AAFP points out in its own article advising practices on how to cope with the cuts, the deadline for opting out of Medicare for 2010 passed March 17. However, physicians may choose to opt out of the Medicare system by becoming private contracting physicians, agreeing to bill patients directly and forgoing any payments from Medicare to their patients or themselves. Physicians who are considering this route can opt out of Medicare 30 days before the first day of the next calendar quarter, which begins on Oct. 1.

Other strategies recommended by the group for dealing with lower Medicare reimbursement include moving nonurgent Medicare/TRICARE patients to the bottom of their office schedules, getting more Medicare patients in for self-pay routine physical exams, stepping up ancillary services and drawing more families for back-to-school and sports physicals during the summer months.

"Physicians need to be creative, and they're going to have to rely on their practice managers to help implement some of these things," said Cindy Hughes, CPC, a coding expert in the Academy's Practice Support Division, adding that practices already operating on thin margins may have to also consider cost-cutting measures, at least in the short term.

To learn more,
- see this article by the Associated Press
- read this Politico piece
- here's the report in USA Today
- check out the recomendations from the American Academy of Family Physicians

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