A federal panel’s recommendation to get rid of the Sustainable Growth Rate (SGR) formula by cutting specialists’ Medicare payments is “completely untenable,” according to Tim Laing, MD, chair of the ACR’s Government Affairs Committee.
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Dr. Laing says that the decision by the Medicare Payment Advisory Commission (MedPAC) on October 6, 2011, to reduce payments for specialist services by 5.9% for each of three years, and then freeze them for seven more years, would likely threaten patient access to rheumatology.
“Some physicians may refuse to see new Medicare patients altogether, or they may ration them,” Dr. Laing says. “They may decide that they want to see fewer of them because people with other types of insurance coverage are able to more fairly reimburse them for their services. At some point, if your overhead rises too high relative to your income, your practice becomes difficult to go forward with.”
The MedPAC recommendations may be taken up by the federal “super committee” tasked with finding at least $1.5 trillion of deficit reductions, although Dr. Laing does not expect that committee’s November 23 deadline to force a decision on the SGR issue. Instead, he says, the scheduled 27.4% SGR cut on January 1, 2012, is what will likely motivate politicians and physicians to find a compromise.
To get there, numerous specialists testified last month at the Commission hearing to oppose the proposed cuts, which said specialists believe unfairly target them over primary care physicians.
“The specialties that you saw testifying at that meeting were, in some sense, the odd players out,” adds Dr. Laing. “They were the ones who don’t receive the political sympathy of the primary care mission, and they also don’t enjoy the incomes of those specialties that are more procedurally based. Yet, their services are critically necessary. We take care of many patients with severe arthritis, and those patients would go wanting without us. They have complex conditions that require our services. So, I think that for many of us in rheumatology, the concern is that the system is further warped to dis-incentivize or to push incentives toward other specialties.”
Dr. Laing remains optimistic that a deal will be struck in the coming weeks to avert the 27.4% cut to SGR, at least for a period of time. In part, he thinks the amount of upcoming healthcare changes—from electronic medical records to the newest version of the International Statistical Classification of Diseases coding system to accountable care organizations (ACOs)—will help spur a solution.