College of American Pathologists
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February 26, 2010
© 2010 College of American Pathologists
Special Report
Physicians Brace for SGR Cuts –
Partisan Politics Are to Blame
Physicians Face 21.5% Cut in Medicare Rates on Monday,
March 1

Despite the Senate’s efforts yesterday and today to vote on a bill that would prevent the SGR-mandated 21% Medicare physician pay cut for another 30 days, one Senator’s objections have blocked the chamber from voting, virtually ensuring the SGR freeze and other critical program extensions will expire on Sunday, February 28.

The bill, H.R. 4691, the Temporary Extension Act of 2010, passed in the House of Representatives on Wednesday, with extensions for federal unemployment benefits, COBRA assistance, and small business loan guarantees, and SGR, among others. These were among the provisions included in the bi-partisan jobs bill announced by the Senate Finance Committee earlier this month.

Senator Jim Bunning (R-KY), claiming he’d been ambushed by Democrats, objected to the $10 billion these extensions would add to the budget deficit. According to the New York Times, Bunning said Democrats has caused their own problems by dropping the program extensions from the bipartisan jobs bill that would have been required to meet the Senate’s newly passed “pay-go” rules for not adding to the deficit. As a result, the retiring Republican has maintained his objection to prevent the bill from being brought to a vote.

With the Senate adjourned for the weekend, there are just two possible outcomes to this impasse. The first is for the Senate to act quickly when they return from the weekend to avoid a disruption of benefits. However, this is not guaranteed given that Senator Bunning has been adamant in his opposition to passing this bill. Senate rules allow a single senator to object to taking up a bill, slowing the process, until agreement can be reached.

A less attractive possibility is the provisions will be allowed to expire until they can be taken up in an alternative measure or a series of smaller bills scheduled to be introduced in a matter of weeks.

Right now, a seven-month extension of the SGR freeze, retroactive to January 1, 2010, is included in H.R. 4154, American Workers, State, and Business Relief Act of 2010. This bill also includes a one-year extension of the TC Grandfather, also retroactive to January 1, 2010.

Senate Democrats have indicated they will take up this bill in the coming weeks, although this is not certain.

In anticipation of such legislation, the Centers for Medicare and Medicaid Services (CMS) announced they will instruct their contractors to hold Medicare physician claims for 10 business days, effective Monday.

The American Medical Association has issued a call to action, below, and posted a Medicare Payment Action Kit on the AMA website, including information on Medicare participation options. The document details three Medicare contractual options for physicians: sign a PAR agreement and accept Medicare’s allowed charge as payment in full for all of their Medicare patients; elect to be a non-PAR physician, which permits physicians to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims; or become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves.

The AMA urged physicians to contact Congress and urge them to repeal the sustainable growth rate (SGR) formula once and for all. Call now, using the AMA’s Grassroots Hotline: 1-800-833-6354.

CAP will continue to advocate for a speedy solution to this impasse with no disruption of medical services to Medicare patients. We will continue to closely monitor this issue and keep members informed through Statline.

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