Today President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, more commonly known as the “doc fix”.This defers the slashing of Medicare reimbursements to doctors by 21.3% for services rendered as of June 1. However, this “reprieve” is only in effect until November.

Mr. Obama stated “I believe we need to permanently reform the Medicare formula in a way that attacks our fiscal problems without punishing our hard-working doctors or endangering the benefits on which so many of our seniors rely”.

Although grateful that the cuts have been staved off, most healthcare providers and leaders of organized medicine are repulsed by the lack of a permanent solution. According to Lori Heim, M.D., president of the American Academy of Family Physicians, “piecemeal approaches merely continue the uncertainty about the reliability of Medicare”. “The stability of federal payment is crucial to the success not just of Medicare but health reform as well. The health reform legislation calls on physicians to invest in changing their practices with health information technology, with new practice models that take time and money to implement, with new accountability standards and performance measurement reporting. Physicians can’t invest in change if they can’t count on payment for their services.”

Upon the termination of the new bill in November, Medicare cuts are slated to be slashed by 23% and then elevated to 30% by January.

It is clear that most physicians are uneasy about the shaky, temporary stability of Medicare reimbursements. For those doctors that still accept payment of Medicare, many are reevaluating their situation. They are weaning themselves from the system by decreasing the number of Medicare patients they see, limiting the practice by not accepting any new patients and seriously considering separating themselves out of fear from reliance on the government program.

For many physicians, the decrease in Medicare reimbursement is more than just a diminishing of salary despite increased expenses. It is a fight for economic survival to keep their doors open. This is one more nail in the coffin of private practice as we know it.