Medicare Payment Cuts Still on the Horizon

Under current law, Medicare physician payments are scheduled to be cut 21 percent, effective Jan. 1, 2010. House and Senate leaders on have said that action will be taken to avert the cut. The U.S. House of Representatives recently passed H.R. 3961 to permanently repeal the current Medicare physician payment policy (sustainable growth rate or SGR) and establish a new framework that eliminates all of the forecasted SGR cuts and corrects serious deficiencies in the update formula. The health system reform bill under consideration by the full Senate, H.R. 3590, provides for a modest update of 0.5 percent in 2010 but retains the flawed SGR formula and subjects physicians to a 23 percent cut in 2011. While SGR repeal is an essential element of health reform, it is being pursued through separate legislative vehicles for budgetary purposes.

If Congress is unable to complete action on pending legislation to repeal the SGR before Dec. 31, there may be a need to get legislation passed to allow for a short-term extension of current payment levels for a 30-day period to facilitate final action to enact a permanent repeal of the SGR.

Realizing the uncertainty of the Medicare physician payment situation and because of recent revisions made to the 2010 Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services has extended the 2010 Annual Participation Enrollment Program end date from Dec. 31 to Jan. 31. The effective date for any participation status change during the extension, however, remains Jan. 1 and will be in force for the entire year. Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are received or post-marked on or before Jan. 31. The AMCNO will continue to obtain updates on this issue and provide additional information to our members as it becomes available.