The detested “sustainable growth rate (SGR) law by which Medicare reimbursements are determined still threatens to decrease payments to physicians by 24% today, April 1.
If removal of this bill is enacted by both houses of Congress and approved by President Obama, it would go a long way to removing the noose over the head of physicians who rely on reimbursement for their large medicare and medicaid patient population. In addition, removing the SGR would help shift payments toward a value-based reimbursement model instead of the current fee-for-service that we have now.
According to Molly Cooke, MD, President of the American College of Physicians (ACP),:
“We certainly hope the bill will pass. We see it as a tremendous opportunity to get this whole SGR madness behind us once and for all and start turning our attention to more productive work on improving the way patients are cared for and physicians are paid for their care.”
The bill provides participating doctors and other eligible professionals (including midlevel practitioners) would be subject to a new merit-based incentive payment system (MIPS) that would consolidate the current Physician Quality Reporting System, the meaningful use electronic health record (EHR) incentive program, and the physician value-based modifier (VBM) program, which starts next year and will affect all physicians by 2017. The rewards and penalties in the MIPS would replace the carrots and sticks in the 3 current programs, starting 2018. From 2014 until 2018 there would be an annual raise of .5% for Medicare payments.
Other Bill Provisions
The Centers for Medicare & Medicaid Services (CMS) to collect information from practices to identify potentially misvalued services. That analysis could lead to a redistribution of a small percentage of Medicare payments;
• The use of clinical decision-support tools to determine the appropriateness of imaging tests; and
• The publication of MIPS quality and resource use data on CMS’ Physician Compare Website.
Nationwide medical societies support the SGR replacement legislation since it has been threatening the income of most doctors as of 1997. Every year when it comes time to renew the SGR or repeal it, Congress has enacted a series of “doc fixes” to put off legally required pay cuts since 2003.
However, each year since 2003, we have seen more physicians give up participation in Medicare or ween the patient list of Medicare patients as they evaluate the percentage of patients in the CMS program and how much a decrease would hurt. (or make them close their office doors from inability to cover costs). We have also seen a flight of physicians over the last decade go from private practice to being employees of hospitals or large medical corporations. This has led to speculation as to whether the “Era of Private Practice” is gone and whether “private practice is dead”.
What has been your experience? Have your personal physicians become harder to see or no longer around? As a physician, have you closed your doors to private practice or to seniors in the community?
Share your views with us in the comment box below.