Rheumatologists should expect at least one more time-stamped extension to the Sustainable Growth Rate (SGR) formula before Congress makes any lasting changes to it, according to two experts. “Our best intelligence is that it’s probably going to be a 10-month fix to get us through the end of the year,” says Katie Jones, senior specialist of government affairs for the ACR. The short-term fix is the latest “band-aid” to the fatally flawed formula, adds Tim Laing, MD, chair of ACR’s Government Affairs Committee.
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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. Some rheumatologists and other specialists felt the MedPAC measure unfairly targeted them over primary care physicians, and they took their concerns over the proposal before Congress (see “Congress Weighs Medicare Cuts Again”). They argued that the move would gut their revenue streams and push some practices out of business.
The MedPAC recommendation “hasn’t gone anywhere,” Jones says. “We haven’t seen any members of Congress pick it up. I think that MedPAC was under pressure to put something forth and they said, ‘Okay, here’s our idea.’ But we have not seen that that proposal will get legs.”
Some specialists feared the MedPAC suggestion would be acted on by a federal “super committee” that was tasked with finding at least $1.5 billion in deficit reductions, but that committee stalled last year and took no formal actions.
Complicating the discussion further is the pending 27.4% SGR cut. Under a compromise reached at the end of 2011, the current deadline for the cut to go into effect is March 1.
“Doctors treating Medicare patients are wondering what their reimbursements will be,” U.S. Rep. Dave Camp (R-Mich.), chairman of the House’s Ways and Means Committee, said in prepared remarks in mid-January. “Even more importantly, the seniors who rely on these doctors for critical medical care are left wondering who, if anyone, will treat them in March.”
The experts interviewed for this article believe Congressional leaders will delay that cut again to the end of this year. “That will buy enough time for the parties—plural—to get together and work out a permanent fix,” Dr. Laing says. “And that’s really what’s needed here…enough time to really come up with a viable solution, rather than one house passing something to another that’s dead on arrival. They really need to have time to work out something that’s viable.”
In the meantime, Dr. Laing continues, rheumatologists have little choice but to wait.
“It’s very stressful,” he adds. “It’s very difficult to run a clinical operation and provide expert medical care while you’re worried whether or not the business foundation of your practice is viable.”
Medicare cuts would affect the bottom line, says Jones, “especially for solo practitioners—that’s a 27% cut to their revenue stream.”
Jones notes that the ACR continues to monitor Congressional discussion on the topic as it advocates for a permanent solution to the SGR formula. She said the issue of a lame-duck Congress is a wild card in how much progress will be made.
“Obviously, the ACR is opposed to these short-term, band-aid fixes,” she adds. “They just increase the cost of the long-term repeal. It’s time to get together, get a proposal, and fix this thing.”
Richard Quinn is a freelance writer based in New Jersey.