Florida doctors are holding their collective breath as Republican and Democrat Congress people play chicken with the federal budget. That’s because this year physicians face a 27 percent pay cut from Medicare that starts this week unless Congress votes to override the scheduled fee decrease.
If nothing is done, many South Florida doctors interviewed said they would consider dropping Medicare altogether. “I don’t want to do it,” said one internist who asked to remain anonymous, “but no business can sustain a reduction of almost 30 percent.”
Both the American College of Physicians and the American Academy of Family Physicians, organizations that represent primary care doctors who care for the elderly and disabled, have sent letters to their members outlining dropping Medicare as one option if Congress lets Medicare slash their fees.
All lobbying groups for physicians have urged Congress to permanently fix what is known as the Medicare Sustainable Growth Rate (SGR) which is at the heart of the cuts.
SGR is the payment method that Congress enacted as part of the Balanced Budget Act in 1997 to ostensibly help the Centers for Medicare and Medicaid Services (CMS) control costs. Unfortunately the way the conversion factor has worked, physician payment updates have been going steadily down since 2002 despite the fact that actual physician input prices have gone up.
For 2002, payment rates were reduced by 5.4 percent. Recognizing the inherent problems with the SGR formula, rather than modifying or eliminating it, in subsequent years Congress has overridden the formula, specifying small increases or payment freezes instead of large cuts. And most of the time, this so-called ”patch” occurred at the eleventh hour, keeping doctors perpetually uncertain about whether the cuts would take place that year or not.
With only a few days before January 1, doctors are more uncertain about the future than ever. If fees are cut, doctors will not only see reductions in Medicare fees, but also from Medicaid and private insurance, since their payment rates are tied to what Medicare pays.
“I don’t think Floridians appreciate the significance of this,” said a Boynton Beach internist who only cares for Medicare aged patients. “I hate saying this, but I am seriously thinking about retiring this year if nothing is done.”
Even if a patch does occur for 2013 , a cumulative payment rate reduction of 41 percent is scheduled through 2016 (9.9 percent on 1 July 2008 and approximately 5 percent annually thereafter).
When asked what should be done, several of the doctors interviewed suggested that Floridians call their Congress people and insist they fix SGR once and for all.