Rheumatologists React to Looming Medicare Payment Reductions

In the midst of flat reimbursement rates and growing expenses, rheumatologists and other physicians are facing yet another potential cut to Medicare reimbursement rates on January 1, 2012: an unimaginable 29.5% across-the-board cut because of the sustainable growth rate (SGR) formula that currently determines reimbursements.

The Medicare Payment Advisory Commission (MedPAC), established by Congress to provide guidance on issues affecting the Medicare program, has approved a recommendation for paying for a permanent SGR repeal. Their plan would repeal the SGR’s annual reductions in Medicare payments and the need for Congress to intervene to avert those cuts. However, in order to pay for the repeal, MedPAC has recommended that Congress freeze reimbursement rates for a small group of primary-care physicians, and cut all other reimbursements, including those for rheumatologists, by 5.9% each year for three years, followed by a freeze in rates. MedPAC’s plan, while arguably well intended, may be just as threatening to physicians’ ability to see Medicare patients as the immediate cut that the SGR would impose.

Another issue of concern is an additional 2% cut to Medicare payments beginning in January 2013 if the congressional “supercommittee” does not come to an agreement on an acceptable package of deficit reduction measures by November 23rd.

It seems obvious these looming cuts, which get larger each year, threaten Medicare patients’ access to care. But what are rheumatologists saying? We asked practicing rheumatologists: “How would the SGR or MedPAC cuts affect you? How would these cuts affect your patients?” Here are some of their responses.

Kelly Weselman, MD, Wellstar Rheumatology,
Sandy Springs, Georgia

“A 29.5% cut to physicians’ pay will have an immediate effect on our ability to see and care for Medicare patients. These patients are generally the sickest and require the most time and resources to care for, due to their multiple comorbidities. In addition, stricter formulary restrictions and more stringent prior-approval processes for Medicare make it even harder to care for this at-risk population. Physicians will simply not be able to provide the necessary care and still run a high-quality medical practice. The proposal by MedPAC to cut specialists 18% over three years is not an acceptable alternative.

“The cost to run a medical practice increases significantly every year. To maintain offices, retain quality staff, and cover employee benefits requires ever increasing resources. In addition, mandated technology services and new required administrative processes chip away at ever tighter office budgets. To think that any rheumatologist can continue to practice with any proposed pay cut is unrealistic. As more providers close to Medicare due to these issues, fewer physicians are left to care for patients with fewer resources. The resulting lack of providers will lead to an increased utilization of emergency and hospital services and an overall increase in the cost of care.”