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The fix is in – for Medicare physician reimbursement…for now

Last night the Senate passed a bill postponing the cut for Medicare physician reimbursement that was scheduled to take effect at the end of this year. When signed by President Obama, the 13 month fix will freeze Medicare physician fees at their current level until the end of 2011, ostensibly giving Congress time to come up with a more permanent fix.
If history is any guide – and it almost always is – there won’t be a permanent fix; instead Congress will punt once again, primarily because almost any revamp of the fee schedule will require ‘officially’; adding over $300 billion to the deficit.
Still, for at least the next 13 months, Medicare and Tricare (military family health insurance) beneficiaries will not be threatened by the possibility of their physicians refusing to accept the fee schedule.
According to Dow Jones, “in order to pay for the extension, the bill contains a change to the recently passed health care overhaul, requiring that individuals repay excess federal subsidies for health insurance if their income rises.
Under the law, the subsidies for people earning up to 400% of the federal poverty level are calculated based on a person’s expected earnings. Repayment of those subsidies had been capped at $250 per individual or $400 per family, in the event that income exceeded expected levels. The law passed by the Senate Wednesday removes those caps and replaces them with a sliding repayment scale.”
What does this mean for you?
For workers comp, no change is good news, as it ensures there will be little need for states to rejigger their fee schedules to address Congress’ whim.
For more discussion of this issue click here.

One thought on “The fix is in – for Medicare physician reimbursement…for now”

  1. The ACC is pleased with the 12-month fix, but this solution is far from good enough. The ACC will continue to work with the medical community in pushing Congress to reach a permanent alternative to the SGR—one that rewards physicians based on quality, rather than quantity.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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