Time tight in Medicare fight to defend some pay provisions, block add-ons

Rural physician payment extensions and therapy cap exceptions are among the items given a temporary reprieve in the Medicare/SCHIP package.

By David Glendinning, AMNews staff. Jan. 21, 2008.

Washington -- With just six months before many provisions in the new Medicare law expire, physicians already are hastening to get several payment provisions extended. At the same time, they're trying to prevent lawmakers from tacking initiatives opposed by organized medicine onto any payment reform legislation.

The "Medicare, Medicaid and State Children's Health Insurance Program Extension Act of 2007," which turned a 10.1% across-the-board Medicare physician payment cut into a 0.5% increase, included additional Medicare language that aims to help physicians in certain areas and within certain specialties. The American Medical Association and other physician organizations pushed for longer extensions. But as with the across-the-board payment boost, most of these provisions will expire June 30 unless Congress passes additional legislation to renew them.

Congress and the White House agreed to extend a floor of 1.0 on Medicare's work geographic practice cost index, or work GPCI, which helps determine how much physicians in different parts of the country are paid for the work they do in providing care.

The geographic work adjustment produces lower payment rates in rural areas, where the cost of practicing medicine is typically lower than in urban areas. But many physicians complained that the formula was reducing their payments too much. The floor helps rural doctors who are paid less for their work when compared with their urban counterparts.