TOPEKA — The American Academy of Family Physicians, based in Leawood, has some issues with the Centers for Medicare and Medicaid Services' recently released Medicare physician fee schedule for 2015. But the doctors' group blames Congress more than CMS.
The biggest issue is the so-called sustainable growth rate formula, which Congress enacted in 1997 to hold Medicare spending at or below the U.S. economy's growth rate.
To comply with the law, CMS proposes reductions in the reimbursement rate for doctors every year. And every year, Congress suspends those cuts. Next year’s reduction in physician fees would be 20.9 percent.
Tennessee physician Reid Blackwelder, who serves as president of the American Academy of Family Physicians, said if that cut is allowed to take effect, some doctors may have little choice but to stop seeing Medicare patients.
“The patient, if we’re still seeing them, will still come in and get care, but I will not be paid for even the cost of that care," he said. "And that will make it very difficult for me to pay my overhead, pay my rent, pay my staff — to keep the doors open.”
Blackwelder says both political parties in Congress want to end this yearly game of chicken by doing away with the sustainable growth rate formula. The challenge, however, is coming up with a way to fully fund Medicare without those cuts.
In a news release issued by the AAFP, Blackwelder added, “Failure by Congress to repeal the long-standing SGR overshadows the 2015 proposed fee schedule’s new and commendable code for chronic care management services."
Primary care physicians are well-suited to oversee care for elderly and disabled patients with chronic conditions, he said, and the new code for these services recognizes the work outside the exam room required for coordinated care.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based.”