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Physician Payment: The Issues Never End

November 1, 2013 | Comments Off on Physician Payment: The Issues Never End
Posted by Frank Ciesla

In light of all of the issues facing the Congress—the budget, the debt ceiling, the sequester—an issue of substantial importance to providers is the automatic Medicare cut to fees paid to providers which will go into effect on January 1, 2014.  The implementation of the Sustainable Growth Rate (SGR) will impact the ability of physician practices or other health care providers, who are providing physician services, to Medicare patients to be adequately reimbursed for the services provided.  We have discussed this in numerous blogs [(1); (2); (3); (4); (5); (6); (7); (8); (9); (10); (11); (12); (13); (14); (15); (16); (17); (19)].  We have also discussed the notice that a physician must provide to Medicare patients if a physician no longer wants to take care of them.

Following is a link to an article ( in regard to the most recent proposal in regard to addressing the SGR.  As you can see from the article, while it proposes not to implement the SGR reduction on January 1, 2014, it proposes to freeze Medicare payments for a period of 10 years and to provide doctors bonuses for agreeing to accept an alternate payment method.  Obviously, physicians will have to see what the alternate payment method is to determine whether or not they will elect to continue to provide services to their Medicare patients.

One of the major concerns that needs to be addressed by the health care providers in accepting any alternative payment method, is the necessary cooperation of the beneficiary in following the medical regime proposed by the physician to maintain or improve the beneficiary’s health status.  Unless there is an effective methodology for assuring compliance by the Medicare beneficiary, the Medicare program has effectively shifted the consequences of the lifestyle of the Medicare beneficiaries, from the Medicare program, to the individual practitioners.  This issue will become a greater issue going forward, as the Medicare program and many other health care programs, implement “alternative fee arrangements,” based upon outcomes, upon the health care providers.


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