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CMS delays bad news, but sees no easy fix to Medicare doctor fees

The Bush administration and physicians urge Congress to quickly address Medicare payment problems during its lame-duck session.

By Markian Hawryluk, amednews staff. Nov. 18, 2002.

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Washington -- Physician hopes for an easy fix to Medicare payment woes were dashed when the Centers for Medicare & Medicaid Services confirmed Oct. 31 that doctors would face an average 4.4% cut in 2003 unless Congress steps in.

Despite an 11th-hour delay in publication of the final physician payment rule and persistent rumors that the Bush administration would act on its own to avoid the cut, CMS Administrator Tom Scully said there was "no doubt" that no administrative fix was forthcoming.

"When the rule comes out, it is likely to be a -4.4% conversion factor, which we think is not appropriate, is not good health care policy and absolutely should be changed by Jan. 1, 2003," Scully said. "However, under the law, we are required to put it out."

The scheduled Nov. 1 publication of the rule containing the 2003 update was delayed due to a problem with payment levels for anesthesiologists' practice expense costs, Scully said. In late October, the agency received new data that called into question its previous decision on anesthesiology payments. Because such changes must be made on a budget-neutral basis, increasing anesthesiology reimbursement would require an across-the-board cut in other payments.

"We were nervous about doing that in an environment where everybody else is going down 4.4%," Scully said. "Based on the late change in the data we have, we think we may have made the wrong call, and unfortunately, it affects everybody, not just the anesthesiologists."

Scully said he expected the rule to be delayed only briefly and that it certainly would be out by Dec. 1. That is the latest that CMS can notify Medicare carriers of the change in payment rates for them to program their computers to pay claims correctly at the start of the year. [...]