Time is of the essence for Medicare fee fix

April 1, 2011

Organizations representing ophthalmologists and other physicians' groups are urging Congress to find a solution this year to the flawed payment formula that requires physicians to take a 29.5% pay cut in January 2012.

Washington, DC-Organizations representing ophthalmologists and other physicians' groups are urging Congress to find a solution this year to the flawed payment formula that requires physicians to take a 29.5% pay cut in January 2012.

"As work begins on the Fiscal Year 2012 budget resolution, we believe that this is the year for Congress to make eliminating the SGR (sustainable growth rate) one of its highest priorities," the organizations said in a letter to both houses of Congress. The American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) were among 131 medical societies and associations that signed the March 10 letter.

The scheduled pay cut, mandated under the statutory formula known as the SGR, has called for slashed rates since 2002 for all physicians who treat Medicare patients. Eliminating the SGR has been a priority for the AAO and ASCRS, whose members treat more Medicare patients than any other specialty.

"We will continue to work with Congress to fix this untenable situation so doctors no longer have to worry about the stability and adequacy of their payments from Medicare," wrote Jonathan Blum, CMS' deputy administrator and director.

While Congress has stepped in every year since 2003 to prevent a permanent cut, the debate has resulted in short-term solutions and retroactive increases that have created paperwork nightmares for practices to manage.

On Dec. 15, President Obama signed legislation halting the scheduled pay cut for 2011, ending a year in which physicians endured five scheduled-and averted-cuts.

"On three occasions, Congress failed to act before cuts were implemented, causing disruptions in processing Medicare payments," the medical organizations noted in their letters to the House and Senate leadership. "These payment uncertainties and delays created serious problems for many physicians' practices and jeopardized seniors' access to care."

Senators and representatives of both parties, as well as President Obama, have expressed support for permanently addressing the SGR, and the National Commission on Fiscal Responsibility and Reform and the President's Fiscal year 2012 Budget recommended eliminating the SGR, the letter continued.

The groups urged Congress to undertake a bipartisan effort to replace the SGR permanently with a workable system that allows physicians to keep pace with costs and ensure that seniors, the disabled, and military families continue to have access to health care.

Cathy G. Cohen, vice president of governmental affairs for the AAO, said the announcement of the pay cut demonstrates the growing size of the problem and underscores the need for a solution.

"The academy is working with [the] American Medical Association, the American College of Surgeons, and others on a long-term fix while CMS is testing a number of physician payment reform options," Cohen said. "The uncertainty and disruptions for both patients and physicians that pervaded 2010 due to the SGR cannot continue if access is to be preserved under Medicare."