Physicians continue to ponder best decision regarding Medicare participation

Key Points

Just before Christmas, Congress delayed a 27.4 percent Medicare fee cut from its original Jan. 1 implementation date. The cut is now scheduled, barring any further congressional action, to take effect Feb. 29.

Doing what they could to help physicians who are uncertain as to whether they should participate in Medicare, the Centers for Medicare and Medicaid Services extended its Dec. 31, 2011, deadline for physicians to notify the agency of their plans to participate in the coming year to Feb. 14, 2012.

According to CMS, contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are postmarked on or before Feb. 14.

Root of uncertainty

The extension for a participation decision probably helped some dermatologists, but without a meaningful decision on reforming the sustainable growth rate (SGR) formula, the root of all of this turmoil will remain. Unless that problem is resolved, uncertainty still hovers, forcing physicians to question whether they should continue treating Medicare patients.

The American Academy of Dermatology Association and other organizations representing physicians have repeatedly urged lawmakers to find a solution.

"With this brief reprieve from the massive 27 percent cut to Medicare payments, Congress now has to enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for taxpayers," said the American Medical Association in a statement after Congress' 11th-hour reprieve.

"Members of Congress need to use this time to work out in a bipartisan manner to provide stability for seniors, military families and the physicians who care for them," the statement said.

AADA disappointment

Just before that action, when it appeared Congress would not pass an extension, AADA President Ronald L. Moy, M.D., blasted lawmakers, saying the organization was "extremely disappointed" at Congress' failure to enact physician payment reform and avoid the cut.

The current system, Dr. Moy said, "threatens the long-term viability of the Medicare program and access to quality healthcare for the country's increasing senior population."

In the past, every time a cut was threatened, physician groups warned that increasing numbers of doctors would stop seeing Medicare patients and thus make it more difficult for the elderly to obtain quality care. Generally, however, the statistics have not shown a significant decline in the percentage of doctors willing to see Medicare patients.

But in his interview with The Washington Post, Mr. Blum expressed continued concern.

"I agree that on a national scale there continues to be high participation in Medicare," he said. "But we are already hearing concerns about certain pockets of the country and certain specialties. And we really are very concerned that given the unpredictability of physician payments, more physicians will discontinue their participation with the Medicare program."

After the two-month extension was passed in December, leaders of both parties were to appoint a committee to negotiate a longer-term solution to the "doc fix," as well as the payroll tax cut and unemployment benefits extensions that were also part of the deal. House Speaker John Boehner (R-Ohio) said he wanted to see a two-year solution for the physician's pay issue - but that still does not mean SGR reform.

Bob Gatty, former congressional aide, covers Washington for businesses specializing in healthcare and related issues. Contact him at bob@gattyedits.com
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