CMS final rule announces a 21.2% Medicare physician payment cut for 2010

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By Gina Brockenbrough
ORTHOPEDICS TODAY 2009; 29:18

A final ruling by the Centers for Medicare & Medicaid Services calls for a 21.2% Medicare physician payment cut and includes refinements that will increase payment rates for primary care services.

Although original estimates projected that Medicare physicians would face a 21.5% drop in reimbursement, the new negative payment update reflects more recent data.

“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” Jonathan Blum, director of the Centers for Medicare & Medicaid Services (CMS) Center for Medicare Management, stated in a press release.

“In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”

Potential ramifications

Jack M. Bert, MD
Jack M. Bert

Orthopedics Today’s Business of Orthopedics Section Editor Jack M. Bert, MD, said that thesustainable growth rate (SGR) formula is flawed and that future cuts may have physicians looking for a Medicare-exit strategy.

“It serves political aims and goals, but does not serve the medical community well,” he toldOrthopedics Today.

“Wondering if a 21.2% payment cut is going to occur distracts doctors, group administrators, and even patients from the larger questions at hand. A cut so drastic and dramatic would create rapid changes in behavior and set into motion future strategic plans which Congress and CMS may not have predicted,” he said

He added, “Eighty percent of the physicians in my 37-man group have decided to electively cease seeing Medicare patients if the 21% reduction goes into effect.”

Bert also projected that practices with large Medicare populations would likely enact overhead reductions within 6 months of the cut.

“It is sadly ironic that the patients who are most vulnerable, require the most attentive care and often require the most complex surgical cases are being devalued by Congress,” he said.

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