Blog | Tuesday, October 26, 2010

QD: News Every Day--Doctors unhappy with Medicare cuts, but can't agree how to fix them


More than two-thirds of doctors will cap the number of Medicare patients they accept if Congress doesn't prevent reimbursement cuts that will take effect Dec. 1. But while doctors don't like how Medicare's reimbursement rates get set, they don't agree on how to permanently fix it.

The Medical Group Management Association reported that 67.2% of medical practices are likely to limit their Medicare populations. Nearly half (49.5%) will stop seeing new Medicare patients and more than one-fourth (27.5%) will stop treating all Medicare patients.

MGMA also reported:
--76.6% will likely delay buying new clinical equipment and/or facilities,
--60.5% will likely reduce administrative support staff,
--54.0% will likely reduce clinical staff, and
--45.3% will likely delay buying electronic health record systems.

Physicians face a 23.6% cut on Dec. 1 and another 6.5% on Jan. 1, or a cumulative 30.1%. If this sounds familiar, it was just in June when Congress failed to prevent cuts from occurring. Although they retroactively paid physicians in full, the consequences included:
--29.5% of practices began reducing the number of appointments for new Medicare patients,
--37.3% delayed buying electronic health record systems,
--31.7% cut administrative staff, and
--27.5% cut clinical staff.

While doctors are reacting now to potential cuts in December, they don't agree how to permanently fix Medicare reimbursement.

Researchers reported survey results ranking several reimbursement reform proposals. Researchers mailed 6,000 surveys to doctors randomly chosen from the American Medical Associations Physician Masterfile. The questionnaire asked doctors to rank rewarding quality with financial incentives, bundling payments for episodes of care, shifting payments from procedures to management and counseling services, increasing pay to generalists, and offsetting increased pay to generalists with a reduction in pay for other specialties. Results appeared in the Archives of Internal Medicine.

Incentives were the most frequently supported reform option (49.1%), followed by shifting payments (41.6%) and bundling (17.2%). Generalists more often supported shifting payments than did specialists. While there was broad support to increase generalists' pay, only 39.1% of physicians supported a proposal to offset the increase with a 3% reduction in specialist reimbursement.

The driving factor was not at all surprising. It's practically common sense. Researchers wrote in their conclusion, "Overall, physicians seem to be opposed to reforms that risk lowering their incomes." A 30% cumulative pay cut for 2011 qualifies as exactly that.