Here’s the take-away: On January 1st –
Physicians that accept Medicare will take a hit of 27% in Medicare Reimbursement!
How can a Physician’s office, Health system, or Hospital keep the doors open
with this loss of revenue? Can you say “We do not accept Medicare patients any
longer”? If you can start... saying it! If you can’t....you better learn how!!!
27% Medicare Pay Cut For Doctors a Real Danger in The
Fiscal Cliff
By Bruce Japsen
From Forbes 12/20/2012
With Congress and
the White House unable to come up with an agreement to avoid the so-called
fiscal cliff — or any other budgetary issues for that matter — a major portion
of pay for doctors from the Medicare program also hangs in the balance.
At issue is a
permanent solution known as the “doc fix” for dramatic cuts to doctor payments
from the Medicare health insurance program for the elderly under the so-called
sustainable growth rate, or “SGR” formula. Without Congressional action,
doctors face a cut in Medicare payments of nearly 27 percent on Jan. 1, 2013.
Only short-term
fixes – 15 of them in the last decade – have been passed as a stopgap measure
to prevent major cuts in physician Medicare reimbursement. The payment formula
came to be as part of the Balanced Budget Act of 1997 and has never been
corrected permanently by Congress.
Unlike past years
when Congress has headed off the Medicare fee cut, inaction in Washington
lately on the fiscal cliff and for an entire year on the “doc fix” has the American
Medical Association, the nation’s largest doctor group, and physicians across
the country worried there will not even be a stopgap measure this time around.
“The threat is
real,” AMA president Dr. Jeremy Lazarus said in an interview. “For physician practices,
it is a terrifying situation.”
The Obama
administration’s latest offer to avoid the fiscal cliff to U.S. House Speaker John
Boehner and Republicans in Congress includes a repeal of the SGR,
which could cost more than $240 billion. Here is a
link to a Washington Post story on the repeal of the ‘doc fix.”
The GOP hasn’t
warmed to White House proposals, which has many lobbies for doctors worried
medical-care providers are going to take a financial hit this time.
Lazarus said
doctors who treat Medicare patients face a significant amount of revenue loss.
“You are talking anywhere from $10,000 or $15,000 up to $35,000 per physician,”
Lazarus said.
The cut will also
be immediate on Jan. 1 because the Obama administration has told doctors it
will not delay processing of Medicare claims.
A Medicare fee cut
could also impact insurance companies like Humana
(HUM), Aetna (AET), UnitedHealth Group (UNH) and other private health
insurers with large businesses providing benefits to seniors through Medicare
Advantage plans. Such privately operated plans contract with Medicare to
provide seniors health benefits.
A cut in doctor
fees would also harm what the health plans can pay doctors and could also
result in physicians fleeing health plan networks, physicians say. Already,
one-third of physicians who treat Medicare patients are not accepting new
patients, the AMA says, in part because they are unhappy with what the program
pays them.
“We haven’t seen
anything as of yet that will avert that cut on Jan. 1,” Lazarus said. “With a
full year to stop this drastic cut, it is absolutely inexcusable that Congress
has failed to act, leaving Medicare patients and physicians to deal with the
consequences.”
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