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    Lack of long-term sustainable growth rate fix continues to frustrate urologists and other physicians

    Could looming pay cuts cause a spike in Medicare opt-outs?


    Bob Gatty
    Washington—For what seems like the umpteenth time, Congress once again has urologists and other physicians who serve Medicare patients wondering what in the name of common sense they are going to do.

    As a result of a classic Washington decision just before Christmas, a 27.4% Medicare fee cut was delayed from its original Jan. 1 implementation date and is now scheduled, barring miraculous congressional action, to take effect on Feb. 29.

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

    "We want to ensure that physicians can make a well-informed decision," explained Jonathan Blum, Medicare's deputy administrator, in an interview with The Washington Post. However, the effective date for any participation status change during the extension remained Jan. 1, and that will be enforced for the entire year.

    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.

    SGR problem remains

    Certainly, the extension for a participation decision was helpful to many urologists.

    However, 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 over the medical community like a heavy fog, forcing physicians to question whether they can afford to continue treating Medicare patients or whether it is time to begin sending out "Dear patient" letters, perhaps using the toolkit provided by the American Medical Association.

    The AUA and other organizations representing urologists have repeatedly and strenuously urged lawmakers to stop procrastinating and avoiding the tough decision on how to cover the $300 billion cost of fixing the SGR.

    With this brief reprieve from the massive 27% 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 AMA President Peter W. Carmel, MD, in a statement following Congress' 11th-hour reprieve in December. "Members of Congress need to use this time to work in a bipartisan manner to provide stability for seniors, military families, and the physicians who care for them."

    In a statement, the American College of Surgeons said: "Access to the nation's health care system and the ability of physicians to provide care should not be viewed as political fodder."


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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