21 percent Medicare physician payment cut

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Sen. Bunning’s Funding Objection Waylays SGR Reprieve
Hope for Retroactive Fix Next Week – Contact Your Members of Congress!

Continued objection by retiring Sen. Jim Bunning, R-Ky., means the 21 percent Medicare physician payment cut will go into effect Monday. Senate Majority Leader Harry Reid, D-Nev., sought unanimous consent to pass an extension bill that delayed several policy provisions that expire Sunday, including the current Medicare sustainable growth rate (SGR) payment levels. The House acted first and passed H.R. 4691, but Bunning’s objection in the Senate prohibits the immediate passage of a unanimous consent request. Bunning, acting without the support of Senate Republican leadership, objected because he was angry about continued Senate spending that was not paid for, and said he would not relent his objection until offsets were found for the additional spending. As a result, the Senate adjourned until Tuesday morning when they will try again to get some form of short relief (30 days).

While the cut will go into effect Monday, disruptions currently are not expected in processing Medicare physician claims, as CMS does not pay claims until at least 14 days after they are submitted. CMS is expected to communicate with participants shortly, but members should expect to submit their claims as they have been (without figuring a 21 percent cut). CMS presumably will hold those claims for the short term in anticipation of congressional action next week to avert the cut.

With the cut going into effect, physicians across the country will likely be forced to make some difficult decisions about their practices and patient mix. In an effort to better understand the actual impact that such a devastating cut will have on surgeons and surgical patients, the Academy joins the American College of Surgeons and other specialty societies in asking that you complete a brief survey. The survey will take less than five minutes to complete and results will be shared with members of Congress.

The Academy continues to work for a permanent repeal of the SGR and expects to be involved in discussions about a long-term solution in a second jobs bill that the Senate will begin working on soon.

Call for a permanent repeal of the SGR formula. We must keep the pressure on Congress!

Based on communications with Academy leadership, members have indicated more than ever before that they are considering opting out of the Medicare program. Members have until March 17 to change their Medicare participation status. Participation options are listed on the AMA Web site.

Another way to take action against the SGR cut: OPHTHPAC plays a critical role in the Academy’s strategy to fight this cut. It is essential that we have every necessary resource in this battle – we need your immediate support! Contribute online today!

For more information, contact the Academy’s Governmental Affairs Division at 202.737.6662.





American Academy of Ophthalmology
1101 Vermont Avenue NW | Washington, DC 20005

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[Meibomian SxN]

...
Sen. Bunning’s Funding Objection Waylays SGR Reprieve
Hope for Retroactive Fix Next Week – Contact Your Members of Congress!

Continued objection by retiring Sen. Jim Bunning, R-Ky., means the 21 percent Medicare physician payment cut will go into effect Monday...

They need to decide on a permanent fix instead of these constant "temporary fixes"!

 

[Visionary]

Looks like something went through today. The focus has been on extension of unemployment benefits, but the temporary SGR fix was part of the original bill that Bunning held up. This article suggests that the bill that was passed was pretty much the same, but anyone know if the SGR portion was actually in it?

 

[orbitsurgMD]

Looks like something went through today. The focus has been on extension of unemployment benefits, but the temporary SGR fix was part of the original bill that Bunning held up. This article suggests that the bill that was passed was pretty much the same, but anyone know if the SGR portion was actually in it?

It extends the current schedule until 1 April. Fitting, I suppose.

If it goes through, we will have in this country the birth of the $400 cataract surgery, phaco and all the trimmings, and 90 days of postop care and the preop visit to boot.

 

[Visionary]

It extends the current schedule until 1 April. Fitting, I suppose.

If it goes through, we will have in this country the birth of the $400 cataract surgery, phaco and all the trimmings, and 90 days of postop care and the preop visit to boot.

Yeah, I saw that. They just keep on kickin' that can down the road, don't they? I really hope whatever health care reform passes (if any) includes a permanent SGR fix. This is the closest we've come to Medicare armageddon.

I'm truly amazed that the SGR issue got absolutely no press. Sure, the "sexy" issue was the unemployment extension, but reports made it seem like that was all the bill addressed. Don't know who's worse: the politicians or the press who cover them.

 

[Meibomian SxN]

It extends the current schedule until 1 April. Fitting, I suppose.

If it goes through, we will have in this country the birth of the $400 cataract surgery, phaco and all the trimmings, and 90 days of postop care and the preop visit to boot.

Looks like they went on Easter break & left the cut in effect...

 

[eyesupply]

It extends the current schedule until 1 April. Fitting, I suppose.

If it goes through, we will have in this country the birth of the $400 cataract surgery, phaco and all the trimmings, and 90 days of postop care and the preop visit to boot.

When that happens, ophthalmologists should sent cataract cases to residency programs so residents can have more practice. The way it is now, some residency programs have good numbers but some residency programs still don't have enough cases for residents. In the UK, they finish with 600 cataract cases, not 50-200 like in the U.S.

Residents work for only $45,000 so all of the $400 surgical fee can go to the medical school and hospital.

 

[orbitsurgMD]

When that happens, ophthalmologists should sent cataract cases to residency programs so residents can have more practice. The way it is now, some residency programs have good numbers but some residency programs still don't have enough cases for residents. In the UK, they finish with 600 cataract cases, not 50-200 like in the U.S.

Residents work for only $45,000 so all of the $400 surgical fee can go to the medical school and hospital.

Unless an attending is surgeon of record, the case cannot be billed. That has been over, settled and done from the early 1990s. Back then, CMS prosecuted several prominent academic clinical departments for billing for resident work. It was painful; the settlements came to the multiple tens of millions of dollars for some departments.

 

[DOCTORSAIB]

TO: All ASCRS/ASOA Members
Date: April 15, 2010

Senate to Resume Consideration of Legislation to Prevent 21.3% Cut to Medicare Physician Payments Through May 31

The Senate will reconvene this morning to resume consideration of an amended version of
H.R. 4851, the Continuing Extention Act of 2010, which would prevent the 21.3% cut in Medicare Physician Payment retroactively to April 1 through May 31. Senator Max Baucus
(D-MT) introduced a subsititute amendment, 3721, to the original bill. The Senate waived a budget point of order on the substitute amendment last evening and will attempt to pass the legislation today.

The amended Senate-passed version of the legislation will then have to be passed by the House, because it is not identical to the original bill that was passed by the House in March, before going to the President. Yesterday, the House Rules Comittee approved a rule that will allow the House to consider the amended version of H.R. 4851 quickly.

As we previously reported, the Centers for Medicare and Medicaid Services (CMS) had indicated that if legislation was not passed by midnight on April 14, Medicare contractors would have to begin processing the claims that have been held since April 1. It is our understanding that once the final bill is signed into law, CMS will issue an official statement. However, if they begin to process the claims at the lower rate, reflecting the reduction, they will reprocess the claims after the legislation is signed by the President.

ASCRS, along with the entire physician community, continues to advocate for a permanent repeal of the Sustainable Growth Rate (SGR) formula. Therefore, we encourage all ASCRS/ASOA members to contact their members of Congress using the Alliance of Specialty Medicine’s toll-free number (1-866-899-4088 and enter code 2525) and tell them that Congress must stop providing short-term, temporary relief and permanently repeal the SGR immediately. Anything short of a permanent solution is unacceptable.

We urge all ASCRS and ASOA members to visit the online Stop the Medicare Meltdown Petition at http://www.ipetitions.com/petition/meltdown/. We also ask that you encourage your patients to join in this effort. A patient flyer, which includes a brief summary of the issue and the website link, is attached for your use.

 

[KHE]

It extends the current schedule until 1 April. Fitting, I suppose.

If it goes through, we will have in this country the birth of the $400 cataract surgery, phaco and all the trimmings, and 90 days of postop care and the preop visit to boot.

So who will lead the charge? Who among you will be the first to go non-par?

 

[DOCTORSAIB]

TO: All ASCRS/ASOA Members
Date: April 15, 2010

10-Day Hold On Medicare Claims Ending
As Senate Action on 21.3% Cut Continues

Today, while the Senate considers legislation aimed at addressing the 21.3% cut through May 31, CMS’ 10-day hold on claims expires. Most of the agency’s contractors must begin processing claims (at the lower rate) that it has been holding since April 1, while some contractors may be able to hold claims for an additional day or two and still meet mandatory prompt payment rules.

Contractors that must begin processing claims today will do so on a rolling basis; that is, they will begin to pay claims for services provided April 1 while holding claims for later dates of service as long as possible.

CMS is expected to instruct its contractors to automatically reprocess claims that are paid at the reduced rate, once legislation that addresses the 21.3% cut is signed into law.

We will continue to update you as the bill makes its way through the Senate and on to the President’s desk. In addition, we will notify you once CMS announces its plans for addressing claims paid at the lower rate and other implications as a result of the cut.

If you have any questions, please contact Nancey McCann, ASCRS Director of Government Relations, at [email protected].

 

[DOCTORSAIB]

Moments ago, the House of Representatives voted favorably on the Senate's amended short-term extenders bill HR 4851, which prevents the 21.3% reduction in Medicare physician payments through May 31 (retroactively to April 1). The legislation will now make its way to the President's desk for signature.



Another temporary fix but at least it went through.

I'm sure they will begin talking about the "doctor fix" again oh say.....May 30.

 

[hbs]

http://www.ipetitions.com/petition/meltdown/

Keep the Pressure on Congress for a Permanent Fix
The Academy has joined the Texas Medical Association (TMA), which has launched a million-signature campaign calling for a permanent solution to Medicare physician payment. If you have not already done so, you are encouraged to sign the TMA's online petition and encourage patients to also join in this effort. A patient flyer (in color or B/W) that includes a brief summary of the issue and the Web link for the petition is also provided.

If you have questions, contact the Academy's Governmental Affairs Office at 202.737.6662.

American Academy of Ophthalmology
1101 Vermont Avenue NW | Washington, DC 20005
Tel. 202.737.6662 | Fax 202.737.7061 | www.aao.org

 

[Visionary]

So who will lead the charge? Who among you will be the first to go non-par?

Ophthalmology, as a whole, and perhaps Optometry to a lesser degree (you tell me), relies so heavily on MC patients that I don't think many can afford to go non-par. As a med ret doc, I see at least 70% MC. Going non-par is simply not an option for me. Many other specialities are not as MC-laden; thus, they can opt out without their practices collapsing. It's a crummy situation.

 

[KHE]

Ophthalmology, as a whole, and perhaps Optometry to a lesser degree (you tell me), relies so heavily on MC patients that I don't think many can afford to go non-par. As a med ret doc, I see at least 70% MC. Going non-par is simply not an option for me. Many other specialities are not as MC-laden; thus, they can opt out without their practices collapsing. It's a crummy situation.

In optometry, it's not so much medicare though we have similar issues with VSP and similar entities. In some parts of the country, if there is one dominant employer or industry, certainly being on "that plan" is generally regarded as important.

But see the problem with this issue, and unfortunately it's the same for us as it is for you is that when you say "it's not an option" the powers that be get that and will continue to turn the thumbscrews.

It's going to require leadership, and more than likely, a doc or a group of docs potentially sticking their necks out to a certain extent. I guess that's the issue...who's gonna be the first to stick their neck out?

For example...insurance companies have an anti-trust exemption. Doctors are not only bound by anti-trust rules but are also specifically forbidden to bargain collectively.

It would seem to me, that those two scenarios right there tilt the playing field SO FAR in favor of insurance companies that it would border on unconsitutional.

Now, I'm certainly not a lawyer and I am certainly NOT familiar with the ins and outs of anti-trust laws but it would also seem to me that what the med societies/optometry societies should do is to get a bunch of money together (it's probably gonna take millions) and hire the absolute top notch anti-trust law firms in the country and have them give directions with respect to what can and can not be done with respect to dropping plans and what arguments could be made in court.

 

[Andrew_Doan]

This is one issue where optometry AND ophthalmology need to fight toghether. I just got back from Capitol Hill at the American Academy of Ophthalmology Mid-Year Forum, and we did not talk to congress about scope of practice issues. It was all about Medicare cuts. The problem is that Medicare rates dictate how much private insurance will reimburse. A 20% or even 40% cut will kill our profession and medicine in whole.

I encourage you all and your patients to contact your local representatives and senators and tell them the system IS broken. If you know of practices that have stopped accepting Medicare/Medicaid patients, then tell them about it. Emails work too as their staffers count these up. If you're an AAO member, login and send a quick e-mail (http://www.aao.org/advocacy/action/index.cfm)

I was told by Senator Feinstein's staff that they need to hear of specific examples where physicians (optometrists, ophthalmologists, and other doctors) have stopped accepting Medicare/Medicare and are affecting "access to care". I told the staff that in Southern California, I know of several practices who have stopped taking Medicare or have converted to cash only practices.

The politicians want to hear from voters. This is an election cycle, and the politicians will listen.

The issue is that voters (i.e. mainly patients) will not say anything until the system is completely BROKEN. At that point, the healthcare system will be beyond repair. This is what I mean:

If 25% of practices stop taking Medicare, there are still 75% of other practices to absorb the Medicare patients. Thus, patients will not have an "access to care" issue because 75% of providers are willing to work at a discount.

I don't know what the threshold is, but let's assume that if 30% of practices stop taking Medicare, the remaining 70% of practices may not be able to "absorb" the Medicare patients seeking care. Thus, this is when "access to care" is an issue. By this point, it may take Congress too long to act, and we may see a domino effect where overwhelmed practices quickly stop taking Medicare patients in attempt to keep their revenue stream high enough to remain operational.

The bottom line is that Congress needs to act now instead of waiting for voters to tell them, "hey... I can't see any docs who will accept my Medicare."

http://www.aao.org/advocacy/