Congress may not find fix for impending Medicare physician rate cut

March 13, 2008

Pro-physician forces are marching down a politically rocky road to avoid an impending 10.6% midyear cut in professional fees covered by the Medicare Physician Fee Schedule.

Pro-physician forces are marching down a politically rocky road to avoid an impending 10.6% midyear cut in professional fees covered by the Medicare Physician Fee Schedule.

The Centers for Medicare and Medicaid Services announced Feb. 1 that federal legislation passed late last year to increase Medicare Part B physician fees by 0.5% and to delay a CMS plan for an across-the-board 10.1% rate cut will expire June 30. As a matter of simple arithmetic, MPFS rates will automatically fall 10.6% without Congressional intervention.

The Senate Finance Committee is drafting legislation to forestall the cuts, according to Orrin Marcella, assistant director of congressional affairs at the American College of Radiology. Separate action is not expected from the House of Representatives.

Whether the yet-to-be-introduced legislation will pass quickly is uncertain, however, despite backing from the American Medical Association, ACR, and other physician advocates.

The December 2007 legislation that delayed CMS's planned rate cuts was the latest in a series of annual Congressional actions that set aside recommended physician rate reductions to meet Congress's own mandate for a sustainable growth rate to regulate Medicare costs.

"A lot of these one-year fixes have never been paid for," Marcella said. "Congress just pushed the debt to future years. That's why we've got such a large looming cut right now, and that is not acceptable."

In December, Congress looked for funding offsets in the Medicare Advantage plans to maintain budget neutrality when it raised the MPFS rates by 0.5%, he said. President Bush first proposed Medicare Advantage and remains a strong supporter.

Faced with a potential veto, lawmakers dared to reallocate only enough funds to support the rate hike for just six months, Marcella said.

The impending cuts would apply to all physicians who treat beneficiaries enrolled in Medicare's outpatient Part B program.

"Congress faces a huge challenge in actually paying for a physician rate freeze," Marcella said.

For more information from the Diagnostic Imaging archives:

New CPT codes raise rates, but billing problems remain

Medicare imaging costs skyrocket, draw scrutiny

Congress delays reimbursement cuts