The notorious sustainable growth rate (SGR) formula for setting Medicare rates was almost delayed, then not delayed, then delayed, passed through with a 21% cut, then not reversed, only to be temporally reversed for several more months with CMS now reprocessing claims automatically. Over the past several months, listservs, blogs, and all professional healthcare websites have focused on this looming disaster. In spite of requests to permanently fix the SGR, it appears to continually get delayed with no end in sight. Nancy Pelosi and others on capitol hill have already voiced their issues with a permanent fix, in spite of multiple recommendations by physicians and congressmen (one interesting idea by Dr. Phil Rosenfeld of Bascom Palmer Eye Institute, recently analyzed in the Wall St Journal, was that by switching all AMD patients from Lucentis to Avastin, hundreds of millions of dollars would be saved).
One question many physicians are asking is: Where is the AMA? Ophthalmologists have stressed frustration with AAO and ASCRS in not taking a more aggressive stance. The problem is that doctors have never lobbied strongly together. Additionally, ophthalmologists not only have to contend with reimbursement rates but also face legal battles with optometrists lobbying for greater scope of practice, all the while trying to update their equipment and EMR systems.
What is the solution? We should develop a way to more strongly unite, but if our efforts fail we should be prepared to react. A 21% cut would not only devastate many practices, but would actually create more unemployment as physicians would have to lay off staff members. Sadly, a 21% cut would not even be the end of cuts according to the SGR. Currently the Medicare physician cut is scheduled to be 23% in December, then nearly 30% in January. At 30%, many practices will have to shut down, and several physicians may choose to retire early than struggle any further. Are there other choices? Is opting out an option? At this point for most practices it is not a possibility. However, there is no question that we are heading to a two-tier healthcare system similar to what is seen in other developed countries. At a previous ophthalmology meeting I had the opportunity to discuss this future with Dr. Uday Devgan MD (click here to watch video). Opting out for many will become the only choice for physicians and will allow them to regain control over how they practice medicine. The timeline to get there, however, is the only unknown.