“Nobody should be treated that way by the political system,” agreed Dr. McDermott, who would like to see the elimination of the SGR formula, which he compared to a live, if yet undetonated, grenade for physician practices.
Explore This IssueFebruary 2013
“Physicians haven’t seen an increase in payment for the better part of a decade,” added Christian Shalgian, director of the division of advocacy and health policy at the American College of Surgeons. “At a certain point, physicians are going to stop seeing Medicare patients.”
Impact on Specialty Practices
Dr. Imber said that otolaryngologists would likely always be paid on a fee-for-service basis in Medicare, because most patients see them case by case. But, while rational restructure might emphasize primary care and prevention, specialty care such as otolaryngology must be more than an afterthought, because many Medicare patients do need such services, he said.
“The current delay on SGR continues the ongoing pay-it-forward policies of Congress for the past 10 years,” said Dr. Imber. “We need to take the next year and really open discussion and take measures to facilitate an appropriate physician reimbursement policy that accommodates both the primary care physician and the specialist. All affected parties need to participate in the process and have a seat at the table.”
Framework for Change
With cuts designed only to fix the budget, Medicare flirts with tremendous access issues as doctors potentially leave the program, said a Congressional aide. “In this fiscal climate, everything’s going to have to be paid for,” he said, and major reforms, beyond those already in the Affordable Care Act (ACA), are unlikely to be put in place while lawmakers grapple with the budget, he added.
For that reason, physicians should focus on working with the ACA as a framework for change, especially since few now believe repeal is viable, said Dr. McDermott. “You’re going to see a debate about the question of how much doctors are paid and who should determine how much they’re paid,” he added. “Doctors are going to have to come to the table and begin to negotiate. Now they’re unfortunately drawn into the discussion in a way that they have not [been] in the past. Nobody who’s rational can look at what we go through to become physicians and end up paying them minimum wage. But there is a reasonable limit.”