SGR Update: What’s Up With That 21 Percent Physician Pay Cut?

Posted on 30. Nov, 2009 by Editor in Provider News

Here’s what you should be watching on Capitol Hill.

It’s that time of year again — the time when we all bite our nails wondering if Medicare will slash physician payments in the New Year.

This year, the drama is more intense as Congress decides whether to permanently repeal the Sustainable Growth Rate (SGR) formula that creates the annual physician pay cut kerfluffle.

Traditionally, Congress has stepped in to reverse such dramatic cuts before they take place, and unless that happens this year, you’ll face a conversion factor of $28.4061 effective Jan. 1, according to calculations published in the Nov. 25 in the Federal Register. That translates to a 21.2 percent cut for CY 2010, the FR notes.

The good news: On Nov. 19, the U.S. House of Representatives passed H.R. 3961, the “Medicare Physician Payment Act of 2009,” by a vote of 243-183. The bill would permanently repeal the SGR and replace it with a formula that physician groups feel more accurately reflects actual costs. The bill also would cancel 2010’s 21 percent cut.

Bill proposes annual reimbursement increases …  

“In 2011 and beyond, Medicare physician payments would be based on the gross domestic product (GDP) plus 2 percent for evaluation and management and preventive services, and the GDP plus 1 percent for all other services” explains the Medical Group Management Association, which supports the bill along with other physician groups. “These service categories would apply without regard to the specialty of the physician providing the service.”

Up next: The bill goes to the Senate, which rejected a similar measure in October because it cost too much, reports American Medical News. More from AMNEws …

Click here to find the 2010 coding & reimbursement update custom-tailored for your specialty.

Tags: H.R. 3961, Medicare Physician Fee Schedule, pay cut, SGR, Sustainable Growth Rate