BALTIMORE — CMS finalized its 2010 physician fee schedule on Oct. 30, and 21.2 percent payment cuts are firmly in place. Unless relief comes in the form of a "doc fix," physicians will feel the pain. However, if the powerful American Medical Association earns doctors a reprieve, home care advocates fear that could put HME on the chopping block once again as lawmakers look to make up the revenue shortfall.
Immediately following finalization of the 2010 payment rule, the president of the AMA issued a strongly worded condemnation of what he deemed the "whopping" cut.
"Permanent repeal of the payment formula is an essential element of comprehensive reform to improve the health system for patients and physicians," said J. James Rohack, MD, president of the AMA. "Security and stability for America's seniors will not be achieved without a permanent solution to the broken Medicare physician payment formula. The U.S. House of Representatives will soon vote on legislation (H.R. 3961) to permanently repeal the current Medicare physician payment formula, and Congress must fulfill their existing obligation to America's seniors as they work to create new commitments to the American people through health reform."
Congress has previously headed off any physician cuts through temporary fixes. In mid-October, however, Sen. Debbie Stabenow, D-Mich., proposed a bill in the Senate (S. 1776) that would amount to a "freeze" that would repeal the current Medicare physician payment system at a cost of about $247 billion over 10 years. That bill, however, failed to move to a vote.
The Senate Finance Committee health reform bill (S. 1796) would raise doctor's payments by 0.5 percent in 2010.
Michael Reinemer, vice president of communications and policy for the American Association for Homecare, said the doc fix may end up waiting in line behind health care reform, but he acknowledges that it is difficult to say at this point.
"The reality is that until there is a permanent fix, which is going to have a big price tag, it is an annual threat to the HME sector simply because they have to scramble and find money in a budget-neutral, or pay-as-you-go, environment," Reinemer said. "So to pay for the doc fix, they must find Medicare cuts, and that puts us at risk even though our reimbursement has been cut over and over."
Judging by the strong words of Rohack, it's clear that physicians will not acquiesce to the cut without a serious fight.
"Medicare's final 2010 payment rule confirms that in 60 days, physicians face steep cuts of 21.2 percent — the largest payment cut since Congress adopted the fatally flawed Medicare physician payment formula," added Rohack. "Access to care and choice of physician for seniors, baby boomers and military families is at serious risk — and Congress must fix the payment formula once and for all this year."
Like last year, the clock is running on the physician pay cut, which is scheduled to take effect on Jan. 1, 2010. According to the AMA Web site, the 21 percent cut will grow to approximately 40 percent by 2016.
"Persistent, looming cuts and low payments reduce access to care and keep physicians from participating in quality initiatives and purchasing health information technology," the AMA said. "Medicare payments should cover the increasing cost of providing care so that seniors can be assured of continued access to physician care."
