Dermatologists Tire of Short-Term SGR Fixes

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stopgap law passed in June, doctors currently are receiving a 2.2% increase in Medicare payments--but only through Nov. 30. In the absence of Congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule for the Medicare physician fee schedule projects an additional 6.1% cut starting Jan. 1. "This means that under current law--that is, in the absence of additional legislative action--if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower than Nov. 1," explained Ellen Griffith Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say that they expect Congress to once again address the pay cut before it goes into effect Nov. 30. But there is a consensus that the temporary fixes are no longer the answer.

"The American Academy of Dermatology continues to believe the only solution is complete reform of the Medicare physician payment system and the repeal of its flawed sustainable growth rate (SGR) formula," said Dr. William D. James, president of AAD in a statement. "Our organization and others in medicine will continue to discuss this issue with members of Congress in the coming months."

"I think what's going to happen in this Congress happened a couple of weeks ago, when it postponed the cuts until Nov. 30," said Rep. Michael Burgess (R-Tex.) at a recent Congressional Health Care Caucus Policy forum. "I don't see anybody working on it hard enough right now to think that there's actually going to be a solution that's on the floor of the House right before or after the election.

"We'll probably do some other temporary patch to get into the next Congress," said Rep. Burgess, who is also an ob.gyn. He added that he hoped that new majority in Congress will be Republican. "If we're going to show that we're different as a governing body in a new majority after the first of the year, we've got to fix this."

In June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix.

"When you talk about how we have a problem, well, I don't see you helping us out," he said. "Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it. You're not helping at all."

CMS officials have repeatedly stressed their commitment to work with Congress to change the payment update formula for physicians' services, Ms. Griffith Cohen of CMS said.

"This short-term relief is critical--but so too is a long-term solution. We will continue to work with Congress to fix this untenable solution, so doctors no longer have to worry about the stability and adequacy of their payment from Medicare," Marilyn Tavenner, the acting administrator of CMS wrote providers on June 30.

And without Congressional action, Ms. Griffith Cohen explained, Medicare is required to follow the SGR formula.

Dr. Ardis Hoven, chair of the American Medical Association Board of Trustees, said in a statement that the "current index is woefully outdated and understates the growing gap between Medicare payments and the cost of caring for seniors."

But according to AMA, the 1,250-page proposed rule has some bright spots.

Dr. Hoven said in her statement that she was pleased to see in the rule "that there is a consensus on the need to update the government index of medical practice costs to reflect the current cost." According to the proposed rule, CMS intends to convene a technical panel to review all aspects of the Medicare Economic Index.

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stopgap law passed in June, doctors currently are receiving a 2.2% increase in Medicare payments--but only through Nov. 30. In the absence of Congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule for the Medicare physician fee schedule projects an additional 6.1% cut starting Jan. 1. "This means that under current law--that is, in the absence of additional legislative action--if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower than Nov. 1," explained Ellen Griffith Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say that they expect Congress to once again address the pay cut before it goes into effect Nov. 30. But there is a consensus that the temporary fixes are no longer the answer.

"The American Academy of Dermatology continues to believe the only solution is complete reform of the Medicare physician payment system and the repeal of its flawed sustainable growth rate (SGR) formula," said Dr. William D. James, president of AAD in a statement. "Our organization and others in medicine will continue to discuss this issue with members of Congress in the coming months."

"I think what's going to happen in this Congress happened a couple of weeks ago, when it postponed the cuts until Nov. 30," said Rep. Michael Burgess (R-Tex.) at a recent Congressional Health Care Caucus Policy forum. "I don't see anybody working on it hard enough right now to think that there's actually going to be a solution that's on the floor of the House right before or after the election.

"We'll probably do some other temporary patch to get into the next Congress," said Rep. Burgess, who is also an ob.gyn. He added that he hoped that new majority in Congress will be Republican. "If we're going to show that we're different as a governing body in a new majority after the first of the year, we've got to fix this."

In June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix.

"When you talk about how we have a problem, well, I don't see you helping us out," he said. "Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it. You're not helping at all."

CMS officials have repeatedly stressed their commitment to work with Congress to change the payment update formula for physicians' services, Ms. Griffith Cohen of CMS said.

"This short-term relief is critical--but so too is a long-term solution. We will continue to work with Congress to fix this untenable solution, so doctors no longer have to worry about the stability and adequacy of their payment from Medicare," Marilyn Tavenner, the acting administrator of CMS wrote providers on June 30.

And without Congressional action, Ms. Griffith Cohen explained, Medicare is required to follow the SGR formula.

Dr. Ardis Hoven, chair of the American Medical Association Board of Trustees, said in a statement that the "current index is woefully outdated and understates the growing gap between Medicare payments and the cost of caring for seniors."

But according to AMA, the 1,250-page proposed rule has some bright spots.

Dr. Hoven said in her statement that she was pleased to see in the rule "that there is a consensus on the need to update the government index of medical practice costs to reflect the current cost." According to the proposed rule, CMS intends to convene a technical panel to review all aspects of the Medicare Economic Index.

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stopgap law passed in June, doctors currently are receiving a 2.2% increase in Medicare payments--but only through Nov. 30. In the absence of Congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule for the Medicare physician fee schedule projects an additional 6.1% cut starting Jan. 1. "This means that under current law--that is, in the absence of additional legislative action--if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower than Nov. 1," explained Ellen Griffith Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say that they expect Congress to once again address the pay cut before it goes into effect Nov. 30. But there is a consensus that the temporary fixes are no longer the answer.

"The American Academy of Dermatology continues to believe the only solution is complete reform of the Medicare physician payment system and the repeal of its flawed sustainable growth rate (SGR) formula," said Dr. William D. James, president of AAD in a statement. "Our organization and others in medicine will continue to discuss this issue with members of Congress in the coming months."

"I think what's going to happen in this Congress happened a couple of weeks ago, when it postponed the cuts until Nov. 30," said Rep. Michael Burgess (R-Tex.) at a recent Congressional Health Care Caucus Policy forum. "I don't see anybody working on it hard enough right now to think that there's actually going to be a solution that's on the floor of the House right before or after the election.

"We'll probably do some other temporary patch to get into the next Congress," said Rep. Burgess, who is also an ob.gyn. He added that he hoped that new majority in Congress will be Republican. "If we're going to show that we're different as a governing body in a new majority after the first of the year, we've got to fix this."

In June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix.

"When you talk about how we have a problem, well, I don't see you helping us out," he said. "Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it. You're not helping at all."

CMS officials have repeatedly stressed their commitment to work with Congress to change the payment update formula for physicians' services, Ms. Griffith Cohen of CMS said.

"This short-term relief is critical--but so too is a long-term solution. We will continue to work with Congress to fix this untenable solution, so doctors no longer have to worry about the stability and adequacy of their payment from Medicare," Marilyn Tavenner, the acting administrator of CMS wrote providers on June 30.

And without Congressional action, Ms. Griffith Cohen explained, Medicare is required to follow the SGR formula.

Dr. Ardis Hoven, chair of the American Medical Association Board of Trustees, said in a statement that the "current index is woefully outdated and understates the growing gap between Medicare payments and the cost of caring for seniors."

But according to AMA, the 1,250-page proposed rule has some bright spots.

Dr. Hoven said in her statement that she was pleased to see in the rule "that there is a consensus on the need to update the government index of medical practice costs to reflect the current cost." According to the proposed rule, CMS intends to convene a technical panel to review all aspects of the Medicare Economic Index.

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov