Congress blocks pay drop, but 21% cut looms in 2010

Washington, DC-Although physician advocacy groups are pleased that Congress was able to block a pay cut for physicians who serve Medicare patients, the American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO) maintain that the hard work is just beginning.

Both groups say physicians and Medicare experts-not staffers and lobbyists-must decide how to reform the world's largest health-care system so that physicians are paid equitably. Such reform must be permanent, long-term, and appealing to a bipartisan, bicameral Congress, they said.

"Hard choices have to be made," said Nancey K. McCann, ASCRS director of government relations. "We can't continue to go down this path."

"We don't view this as a win," McCann said, because a 1.1% update does not keep pace with inflation. ASCRS did not endorse the measure but chose not to speak out against it, she said.

Cathy G. Cohen, AAO vice president for governmental affairs, said Sen. Max Baucus (D-MT), the Senate's finance committee chairman, told medical group lobbyists that the medical community must come up with a plan to present to Congress for how it would change the funding formula, or it will be up to Congress to decide.

"This is something that's going to affect every specialty in medicine, so we really think it needs to be the physician leadership, not staff, coming together to make these decisions," Cohen said. "It's a very exciting time. We've been invited to come to the table and propose a new way to pay physicians, but it's also at great risk."

Medical groups such as the ASCRS and AAO are looking toward the American Medical Association (AMA) to provide leadership in reaching some consensus on changing the payment formula. The AMA said substantial reform to the physician payment question is necessary.

"This congressional debate underscores the need for lawmakers to replace the flawed Medicare physician payment formula permanently so physicians can focus on the real work at hand: taking care of patients," the AMA said in a prepared statement. "Current Medicare payments to physicians are about what they were in 2001, while the cost of running a medical practice has increased substantially."

On the table

A change in the funding formula would affect all physicians. Several groups have already begun to suggest changes.

"While that on paper looks good for surgery and ophthalmology in particular, it would divide medicine in that we would all be lobbying for different conversion factors," Cohen said.

Major procedures-such as glaucoma and cataract surgery-would be in one category, whereas minor procedures-including diagnostic testing and visual field testing-would be in another. Because minor procedures also include magnetic resonance imaging, an area of "explosive growth," Cohen said that category would be in jeopardy of smaller or negative updates.