Congress delays 21.2% reimbursement reduction

January 1, 2010

Once again, urologists have had to face the prospects of huge reductions in their Medicare reimbursement rates because of the inability of Congress to resolve the problems imposed by the sustainable growth rate (SGR) formula, and once again, they must count on a temporary reprieve.

Just before Christmas, while the Senate struggled to pass overall health reform legislation, the House of Representatives voted 395-34 to approve a $636.3 billion defense appropriations bill that includes a delay of a scheduled 21.2% Medicare physician payment cut until Feb. 28, 2010. The cut was scheduled to take effect Jan. 1.

At press time, major medical groups were urging Senate Majority Leader Harry Reid (D-NV) to pursue substantial Medicare payment reform and said a delay, such as that approved by the House, could provide time for such action.

Groups representing physicians, including urologists, continued to seek a solution. The fact that the Senate health reform legislation that was being debated did not solve the physician payment issue, as well as some other significant concerns, prompted AUA to join with 18 other surgical specialty groups to withhold support for that legislation.

"Health care reform is a critical initiative that must be undertaken by U.S. lawmakers in concert with the concerns of the nation's physicians," said AUA Health Policy Chair Steven M. Schlossberg, MD. "In order to truly reform the system, the issues surrounding medical liability, work force, and physician payment must be addressed. All of these areas directly affect physicians' ability to provide quality care to patients."

Fraudulent payments criticized

Meanwhile, as Congress searches for funding to finance the "doctor fix" or help pay for broad health care reform, lawmakers should be aware of the Department of Health & Human Services' 2009 financial report from mid-November, which says that more than $47 billion in questionable Medicare claims were paid over the past year.

In the report by the auditing firm Ernst & Young, HHS was criticized for a wide range of inadequate financial controls. The report also stated that the Centers for Medicare & Medicaid Services should institute improvements to control fraudulent payments. It did, however, acknowledge that the agency has developed controls to prevent fraud and waste from occurring and to uncover instances that had already occurred.

Although the level of improper payments has increased compared with previous years, it is unclear whether this is a result of improved documentation requirements or an increase in fraudulent activity.

"CMS, as the steward of the Medicare and Medicaid programs' administrative and financial operations, has a fiduciary responsibility to ensure that the program funds are spent in the best interest of the beneficiaries and the American taxpayers," the auditors said in their report.