Rheumatologists are already feeling two effects from Congress’ inability to solve sequestration: a 2% reduction in Medicare reimbursements and slashed funding for research financed by the National Institutes of Health (NIH).
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Charles King, MD, chair of the American College of Rheumatology (ACR) Committee on Rheumatologic Care, says that both funding cuts are equally important. The cuts to Medicare reimbursements, which took effect April 1, will directly affect small practices that are already struggling to pay for infrastructure costs related to health-information and other federally mandated technology initiatives.
Cuts to the NIH, which lost 5.1% of its funding at the levels of institutes and centers as of March 1, will also affect rheumatology, where the chronic nature of diseases requires basic and applied research to make advances, Dr. King says.
“[Both cuts are] very significant and they both affect different groups of people more directly,” adds Tim Laing, MD, chair of ACR’s Government Affairs Committee. “A fire and a tornado are both bad. Which one’s worse depends on if you’re in one.”
ACR has lobbied federal officials, and is urging its members to do the same.
“Sequestration cannot become a ‘new normal,’ ” the ACR said in an announcement sent to rheumatologists and others last month.
The sequester is the result of an agreement in 2011 between Congress and President Barack Obama that raised the national debt ceiling, but tied it to unpalatable, across-the-board cuts unless a long-term solution was agreed to. But politicians have been unable to agree on a compromise, and the cuts are now in place.
The sequester is not tied to pending 25% cuts to Medicare payment rates—called for by the Sustainable Growth Rate formula (SGR)—that have been delayed several times. Those cuts are now scheduled to take effect at year end, unless another delay is approved.
Dr. King, a rheumatologist at North Mississippi Health Services in Tupelo, Miss., says the most immediate impact of the sequester will be the Medicare cuts, which will eat into already slim profit margins. That will likely curtail access for patients with rheumatologic conditions, particularly in rural areas and for services such as in-office infusion and osteoporosis testing.
“It’s going to harm access because many physicians in private practice are simply going to say, ‘I can’t make it if revenue keeps going down as overhead keeps going up,’ ” he adds. “They’ll either decide to opt out of Medicare, consider practicing in other models such as hospital employment or concierge practice, or they will retire from practice altogether.”