"At least once a year, I am taken to a precipice known as the SGR cliff (a reimbursement formula used by Congress), which mandates that reimbursement rates are reduced by significant levels unless Congress steps in with its “doc fix” and staves off the cut. This year is no different. The SGR rate will be cut by nearly 27 percent on Jan. 1, 2012 unless Congress acts.
This threatened cut, coupled with rate reductions and penalties already codified under the 2010 health care law and sequestration amount to a systematic targeting of Medicare doctors to pay for deficit reduction.
To be clear, our SGR cliff is not merely an annual exercise. In 2010, we faced no less than five cliffs, sometimes going over, then fixed retroactively after a few weeks of panic and confusion among us and our patients.
If this weren’t enough, the grand promise made to physicians to fix the SGR in the 2010 law actually worsened the situation by once again targeting reimbursement rates and adding reporting and electronic health record mandates. For good measure, the law created the Independent Payment Advisory Board as a means to further reduce reimbursements.
So when Congress went looking for more cuts during the 2011 budget debate, I assumed there would be no more hits coming my way. I was wrong.
The failure of the supercommittee to reach a deal put physicians in line for an additional 2 percent annual cut for the next 10 years in the sequester. Of all the cuts and penalties put on the Medicare provider community, this one is particularly troublesome, given that the ink had barely dried on the law overhauling our industry. But the president and Congress had no qualms in coming back for more.
What is the net effect of these unstable reimbursements, mandated payments and looming cuts? For more and more physicians, these multiple and repeated cliffs give us no choice but to limit the number of Medicare patients we see. Like it or not, this is rationing of care.In fact doctors are leaving Medicare and Medicaid in droves. From the Houston Chronicle:
One hundred and seventy-two doctors formally ended involvement with Medicare last year, the most yet in a surge of "opt-outs" that has claimed more than 450 Texas doctors since 2008. Before 2007, the number averaged a handful a year.ObamaCare and further government involvement with health care will severely limit options for many consumers with it's one-size-fits-all approach, mis-management as detailed above, and bureaucratic complexity and costs. The unspoken effort is to undermine conventional private insurance and force people into the arms of government programs.