Physician Payment Solution Continues to Elude Congress

21.2 Percent Payment Cut Set to Take Effect April 1

March 29, 2010 05:30 pm News Staff

The Senate was unable to pass a one-month Medicare payment extension before adjourning for a two-week recess on March 26, thus allowing a 21.2 percent payment reduction to take effect under the sustainable growth rate, or SGR, formula on April 1.

"Once again Congress has failed to meet the needs of Medicare patients and the physicians who serve them," said AAFP President Lori Heim, M.D., of Vass, N.C. in an interview with AAFP News Now.

The 21.2 percent reduction called for by the SGR was scheduled to take effect Jan. 1. However, Congress passed a short-term patch that delayed the payment reduction until March 1. On March 1, the scheduled cut took effect because the Senate did not act to extend the deadline in time. They later reversed the cut for another one-month period, which is scheduled to expire on April 1.

In the interim, CMS has instructed its contractors to hold payments for services delivered after April 1 for 10 business days or until April 14, which should give Congress enough time to reverse the cut before it actually affects physicians. Congress is scheduled to re-convene on April 12 and is expected to move quickly to reverse the Medicare payment cut.

Although the House approved a bill to provide another one-month payment extension on March 17, the Senate was unable to pass the measure under a unanimous consent calendar.

Heim decried the inability of Congress to pass a long-term solution to the SGR.

"We understand there are multiple issues involved," said Heim. "However, our request is that they stop playing with this issue and resolve it so physicians who have Medicare patients can have a stable future."

The Senate passed a bill earlier this year that would provide a payment fix until Oct. 1, but the measure included off-setting reductions in spending and increases in taxes that are contained in the larger health reform bill that was just passed. Congress cannot use the same offsets in both bills, leading the House to pass another one-month patch to give lawmakers more time to find new budget offsets to pay for the provisions in the bill.