Medicare Cuts Physicians’ Fees 21 Percent

Medicare payments to physicians were reduced 21 percent March 1 after the U.S. Senate failed to stop the cut from taking effect. The Centers for Medicare & Medicaid Services (CMS) instructed TrailBlazer Health Enterprises and other Medicare carriers to hold Medicare physician claims for 10 business days, effective March 1.

The fee cut took effect because the Senate adjourned for the weekend on Feb. 26 without doing what the House of Representatives did - pass legislation that would have delayed the reduction for another 30 days. Senators tried to pass the bill several times on unanimous consent Feb. 25 and Feb. 26, but Sen. Jim Bunning (R-Ky.) objected because the $10 billion cost of the program would not be offset.

Tuesday, March 2, is the earliest the Senate can consider the issue again. Contact Texas Sens. John Cornyn and Kay Bailey Hutchison through the TMA Grassroots Action Center and urge them to ask their colleagues, especially Senator Bunning, to allow the delay to be adopted so patients and physicians won't be hurt while the work to fix Medicare continues.

Congress' decade-long failure to devise a rational Medicare physician payment plan is "an insult to seniors, people with disabilities, and military families," said Texas Medical Association President William H. Fleming III, MD.

"To physicians, this is not a Democrat or Republican issue," Dr. Fleming said. "For 10 years, Congress has known about the faulty payment formula for physicians, and for 10 years it has done nothing to fix it. Now, Congress can't even put its typical 'Band-Aid' on the problem. The 21.2-percent cut that goes into effect March 1 is a debacle, but not fixing the faulty formula reflects an even more basic failure.

"If Congress can't fix this one problem - one that so directly affects patients' access and care - how can we expect Congress to get it right with broader health system reform? Both Congress and the president talk about the importance of physicians being able to care for their patients. Yet actions speak louder than words. Every Texan should be angry and disgusted with Congress for toying with patients. This is truly a sad day for Texas patients and physicians, and for patients across America." 

AMA President Jim Rohack, MD, says the fee cut forces physicians "to consider the difficult decision to limit the number of Medicare and TRICARE patients they see in order to keep their practice doors open."

He urged the Senate to "stop playing games with Medicare patients and the physicians who care for them. It is shocking that the Senate would abandon our most vulnerable patients, making them the collateral damage of their procedural games."

The cut originally was scheduled for Jan. 1, but Congress delayed it until March 1.

Remember, March 17 is the deadline to decide whether to change your Medicare participation status.

Signing a participation agreement means you agree to accept assignment for all covered services that you provide to Medicare patients in 2010. You have three options: 

If you choose to participate in 2010:

  • Do nothing if you currently participate.
  • If you are not currently a Medicare participant, complete the agreement and mail it to TrailBlazer Health Enterprises. The change would be effective Jan. 1, 2010.

If you decide not to participate:

  • Do nothing if you do not currently participate.
  • If you are currently a participant, write to each Medicare contractor to which you submit claims, advising of your termination effective Jan. 1.

If you decide to opt out of the Medicare program:

  • PAR physicians' opt-out affidavit must be submitted 30 days before the next calendar quarter (i.e., Jan. 1, April 1, July 1, and Oct. 1) showing an effective date of the first date in that calendar quarter.
  • Non-PAR physicians may opt out at any time.
  • Before opting out, refer to TrailBlazer's  Medicare Opt-Out Guidelines for Physicians/Practitioners  [ PDF ].

The Participation Agreement (CMS-Form 460) is available on the CD-ROM distributed by TrailBlazer Health Enterprises and is posted on the TrailBlazer Web site.

TMA has developed the Texas Medicare Manifesto II , a blueprint for Congress to follow in adopting a sane payment system that treats physicians fairly and preserves patients' access to care .

Action , March 1, 2010


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