Tim Laing, MD, chair of the ACR Government Affairs Committee, says one of the potential pitfalls of the ACA ruling is that some physicians will interpret it to mean that Congress and the federal government has mostly dealt with the issue of medical funding.
But, he says, rheumatologists need to continue to talk about the Sustainable Growth Rate (SGR) formula before Congress. At issue is the future of rheumatologists’ Medicare payments—including the federal Medicare Payment Advisory Commission’s (MedPAC) recommendation from last year to scrap the formula, reduce payments for specialist services by 5.9% for each of three years, and then freeze them for seven more years—and the 27.4% SGR cut that has been repeatedly delayed by extensions. The current deadline for the 27.4% payment cut to take place is the end of this year.
“Everyone is faced with flat or declining reimbursements,” Dr. Laing says, adding that physicians need to continue to lobby federal officials for a permanent solution to the SGR formula. “Congress needs to be aware of the situation, needs to understand the pressure that’s there because it ultimately affects access to Medicare.”
Dr. Laing has hoped for a long-term fix to the formula that balances patient access and physician reimbursement, but is now fearful talk of the ACA’s approval will lead to less of a focus on solving the problem and the potential for more temporary fixes.
“Medicine deals with uncertainly all the time,” he adds. “You just go forward with what you have and you hope for the best.”
Dr. Flood put it this way: “I feel often like the coyote in the Road Runner cartoon series, where’s he jumped off the cliff, something’s going to happen, but he has no idea what. I think a lot of rheumatologists feel that way. We’re not sure how we’re going to fit in to accountable care organizations or other new care delivery systems.”
Richard Quinn is a freelance writer based in New Jersey.
