Dems Propose Medicare Payment Updates

Only five business days remain before the Continuing Extension Act of 2010 provision that extended the zero percent update to Medicare physician pay rates expires. The American Jobs and Closing Tax Loopholes Act of 2010 (HR 4213), or “extenders bill,” would prevent the 21 percent pay cut from going into effect June 1 and provide payment updates to physicians for the next three years. This would buy Congress some time to work on reforming the sustainable growth rate (SGR) formula, which has repeatedly threatened physician reimbursement for medical services provided to Medicare beneficiaries.

The extenders bill would provide:

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  • A 1.3 percent update to the single conversion factor beginning June 1 and ending Dec. 31.
  • A 1.0 percent update to the single conversion factor for 2011.
  • Updates to separate conversion factors during the SGR reform period, between Jan. 1, 2012 and Dec. 31, 2013.

During the reform period physician services would be categorized as such:

  • Evaluation and management (E/M)
  • Preventative
  • All other

2012 and 2013 rates would continue to increase if spending growth on physician services is within reasonable limits, with an extra allowance for primary and preventive care. Rates could not be reduced in 2012 or 2013, but after that rates would return to their current law levels.

The extenders bill has a long way to go — the U.S. House of Representatives is expected to vote on this bill in the coming days. Thus far, however, it has received minimal opposition.

The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) have said they will support this bill. The American Medical Association (AMA) has also commented on this legislation, saying the short term intervention provides a temporary reprieve but a permanent solution is still needed.

“The pending Medicare proposal treats the symptoms — it’s not a cure for the disease, AMA President J. James Rohack, MD said in a May 20 press release. “We urge Congress to take action well before the next deadline to cure this problem once and for all to preserve access to care for seniors and military families and enable the success of health system reform and delivery innovations.”

You can read the full text of the extenders bill — in particular, Title V-Unemployment, Health, and Other Assistance, subtitle B – Health Provisions, sec. 523 — on the Committee on Ways and Means website.


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One Response to “Dems Propose Medicare Payment Updates”

  1. Rossella says:

    Disclosure: I’m Mary’s Dad and could not be more proud of her and the accomplishments and sussceces she has had in her life. I am really excited about the event at the Harris. I am looking forward to a great evening of dance and probably some tears.Roger Baumgardner

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