2012 Medicare Pay Cut

From a Rheumatology Listserve - passed on with permission from Dr. Hamburger.

Harry

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"To Our Patients No doubt you have heard a lot in the news about the legislation currently
being considered by Congress to deal with a number of very important
financial issues, as well as a petroleum pipeline. We do not see the connection
between passing legislation on social security taxes, or what is commonly called
the "doc fix," and deciding on the merits of a pipeline. We do not take a
position here at RALI about pipelines or social security taxes- each citizen
must think about those issues for themselves. We do take a position on the "doc
fix" bill. The issue was the subject of a very dramatic walk onto the Senate
floor by then Senator Ted Kennedy several July's ago to cast an important vote
to prevent a major reduction reimbursement for medical care for Medicare
patients. Thus this is not a new issue- many of you will recognize this
issue as having resurfaced periodically over the last 3 or 4 years. What is this
current bill about? More than ten years ago the Congress passed laws which determine
reimbursement for medical services provided to Medicare patients. The laws had
formulas which considered the costs of many elements of health care. These
formulas are widely regarded today as flawed by both political parties, and
by physicians and health care policy makers. All agree the formulas need to be
fixed, but to do so will take a consensus in Congress, and these days, getting a
consensus is clearly a challenge that this Congress does not meet successfully
very often. The consequence of the flawed formulas is a marked reduction- about
30% - in reimbursement for services to Medicare patients. That is a very large
reduction, and even more so, when you consider that most medical practices, even
very efficient ones, have about a 55% to 60% overhead cost. From time to time
over the last ten years, the Congress has passed a "patch." Rather than fix the
formulas, they pass a one or two year fix of the problem, kicking the ultimate
resolution down the road to the future. Sometimes, the fixes have only been for
a couple of months. The result is uncertainty for every stakeholder- you, us,
etc. One time, the "patch" was delayed enough that the drop in reimbursement
actually was almost implemented in January several years ago, but CMS, the
government agency that runs Medicare, used bureaucratic manipulations to delay
things for a few weeks, and Congress acted at the last minute.
Now, we are at the brink again. The Senate passed legislation
addressing the social security tax, and the "doc fix" with a two month
fix, attached to a mandate for President Obama to decide about the pipeline, but
the house rejected it. The Senate leaders are saying they will not appoint
negotiators to discuss this with the house. The result is that all of us go into
the holiday period- Medicare patients, and all of us who care for you
- uncertain about what we will face together in January. We think you can easily
understand that it is not possible to run a practice with staff, facilities,
vendors supplying medications, etc with a 30% reduction in reimbursement. We hope Congress will ride to the rescue once again to save us all from the
nightmare that they themselves have written for us. The Congress has known that
this issue had a deadline of December 31, 2011 for resolution for more than a
year, and yet, here we are, ten days away from the end of the year, and they are
apparently wide apart on a resolution. What can you do to protect your health care access in 2012? Contact your
House of Representatives member, and our Senators- Schumer and Gillibrand. Tell
them to do the job we sent them to Washington to do. We did not send them there
to spend half their time fund raising to ensure their own re-election. We sent
them there to honor their commitment to be public servants. None of our elected
officials depend on Medicare for their care- not even those who are over the age
of Medicare eligibility. So they don't have to worry. They have provided the
best healthcare insurance in the country for themselves and their families. We
think they should make sure that the citizens they serve get the same assurance
of access to health care. Let them hear your voices. If we have to have
sleepless nights worrying about what we are going to face in January, we don't
think they should have a restful and peaceful holiday season either. Happy Holidays"

Max Hamburger, MD
In a message dated 12/21/2011 12:00:42 P.M. Eastern Standard Time,
...... writes:Here we go
again for sure, even if it is fixed will cause cash flow interruption for sure
as well as a possible balance forward issue again! I'm interested in how other
Rheum's are preparing for this, especially with buy and bill
infusions…… XXBilling Department Manager
AMA
Alert
Breaking news from the American Medical AssociationDec. 20, 2011Congress fails to avert Medicare payment cutThe U.S. House of Representatives today rejected a Senate bill that would have averted a 27.4 percent Medicare physician payment cut scheduled for Jan. 1 and extended an expiring payroll tax reduction and unemployment insurance benefits. The net result was to leave 2012 Medicare payment rates in limbo.Votes on H.R. 3690.
As originally passed by the House Dec. 13 by a vote of 234-193, the House's version of the bill would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But as a result of disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.On Dec. 17 the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies—including current Medicare physician payment rates—for two months. The rationale for the short-term extension was to avoid disruptions on Jan. 1 and provide time for further negotiations on financing longer-term extensions.House action on Dec. 20.
Following the Senate's action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for today. In the most important vote, the House approved by a vote of 229-193 a resolution that disagrees with the Senate and calls for appointing members to a House-Senate conference committee, which is charged with working out differences between the two versions of the bill.Prior to the House votes today, Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House are departing this evening for the holidays with the understanding that they could be called back to Washington, D.C., on short notice. At this time, it does not appear likely that the outstanding issues will be resolved before Jan. 1.Outlook for January.
On Dec. 19 the Centers for Medicare & Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days—until Jan. 17—to avoid processing payments at the lower rate. After that date, claims will be processed on a first-in, first-paid basis at the reduced rates until the situation is resolved.The House currently is scheduled to return to Washington on Jan. 17, while the Senate is scheduled to return on Jan. 23. However, there are reports that the House may move the date of its return up to Jan. 3.AMA view
The AMA issued strong statements following the House and Senate votes, reaffirming its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal the flawed and disruptive formula once and for all.Throughout the year, the AMA has been pursuing a strategy to repeal the SGR that was developed in consultation with state medical societies and national medical specialty societies. We continued to oppose short-term remedies that serve to make future cuts deeper and the cost of permanent payment reform increasingly steep.Throughout the year, bicameral and bipartisan support has been expressed in Congress for permanently addressing the Medicare physician payment crisis. Nevertheless, physicians and their patients once again find themselves confronting uncertainty and instability. It is long past time for Congress to act decisively and protect access to care for senior citizens and military families who rely on TRICARE—they and their physicians deserve better.The AMA will provide additional updates on the status of the 2012 payment rates as events unfold. With the expectation that Congress will be in recess, we will defer any new grassroots messaging until after the holidays.New grassroots messages will be available after Jan. 1 or earlier if Congress decides to return to Washington between the holidays. Physicians can always view the AMA's latest grassroots messages and reach their federal legislators by telephone using our toll-free physicians grassroots hotline number: (800) 833-6354.