But doctors remain hopeful. One positive sign: Lawmakers on both sides of the aisle recognize that the payment problem must be addressed, said Paul Imber, DO, chair of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Board of Governors Legislative Representatives Committee. He noted that the Senate voted unanimously to pass the one-month payment reprieve. “That’s bipartisan. It crosses all barriers,” he said.
Explore This IssueJanuary 2011
The public, too, is aware of the problem. An AARP survey released in October 2010 found that 81 percent of its members who are enrolled in Medicare and 86 percent of those not yet eligible for Medicare were concerned about the impact the pay cut could have on physician access.
The public’s concern could motivate Congress to act, Dr. Imber said. “A good number of physicians will restrict the access of Medicare patients to their practices if things continue the way they are, so things have to be fixed.”
A May 2010 American Medical Association survey of 9,000 doctors found that 17 percent of physicians are already restricting the number of Medicare patients served by their practices. When asked how they’d cope with a 21 percent cut, more than half said they’d limit the number of Medicare patients they’d treat.
Also on the Medicare front, many physician groups plan to continue their opposition to the Independent Payment Advisory Board (IPAB) created by the health reform law, called the Patient Protection and Affordable Care Act (ACA). The 15-member board is appointed by the President and confirmed by the Senate. If expenditures are expected to exceed the target growth rates set by the law for Medicare, the IPAB must recommend proposals to reduce spending. The IPAB cannot submit proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income Part D subsidies. Through 2019, the board is prohibited from recommending payment cuts to providers, primarily hospitals and hospices, that are already slated for reductions. The IPAB may propose physician payment cuts, however, and this worries doctors.
The Department of Health and Human Services must implement IPAB proposals unless Congress adopts an alternative with equal savings. Although lawmakers can override the board, “it becomes a very political situation,” Dr. Imber said. “To have this independent board is very scary. It needs to go.”
House Republicans may take a stab at getting rid of IPAB, but such a measure would likely fail in the Senate, and President Obama is opposed to the board’s repeal, Hedstrom said. The first set of IPAB recommendations isn’t due until 2014, well after the presidential election in 2012. So the ACS, while opposed to the board, is in a wait-and-see mode while it focuses on ACA issues that come up sooner, she said.