Specialty physicians reject MedPAC vote on Medicare reimbursement

The Alliance of Specialty Medicine soundly rejected MedPAC’s approval of a recommendation that Congress reform the Medicare reimbursement system by reducing reimbursements to specialists by 5.9% per year for 3 years while freezing the reimbursement rate for primary care physicians.

"I am baffled," said Alliance spokesperson Alex Valadka, MD, an Austin, TX neurosurgeon. "It’s as if MedPAC sees no linkage between Medicare reimbursement and access to care for patients."

The MedPAC proposal was unveiled last month as part of a plan to reform the sustainable growth rate (SGR), with recommended offsets. Under the proposal, Congress would repeal the SGR and replace it with a 10-year path of statutory updates. Primary care services’ reimbursement rates would be frozen over the next 10 years and all other services would be reduced by 5.9% per year for 3 years and then followed by a freeze in reimbursement rates for the remaining 7 years.

The alliance responded in a letter to MedPAC Chairman Glenn Hackbarth, JD, noting physician payment increases have already been limited over the last 10 years due to hurried congressional "fixes" to the failed SGR as well as additional cuts imposed by the Medicare program.

"These actions have resulted in physician payment rates that do not cover the increasing costs of practicing medicine, and another 18% cut and 10-year freeze will only exacerbate this problem," the AUA, an alliance member, said in a press release. "Instead, the alliance believes the cost of eliminating the SGR should be viewed as a societal cost and other Medicare providers and/or programs outside of Medicare should share in the cost of the offset."

A urologist on the MedPAC panel pointed out that beginning in 2014, under the proposed plan, a nurse who works in his practice will earn more than he does for "seeing the same patient, with the same code and the same risk."

"That to me is extremely disturbing," said Ronald Castellanos, MD, of Southwest Florida Urologic Associates, Fort Myers, in an interview with MedPage Today.

The MedPAC proposal will now be sent on to Congress.

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