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  • Annual Medicare Physician Payment Updates

    In December 2010, Congress passed and the President signed into law legislation that freezes physicians' Medicare payments at their current levels through next year.  Not only does this action break the cycle of short-term pay fixes that plagued physicians in 2010 but it eliminates the threat of a 2011 payment cut that was projected to top 25 percent according to the Sustainable Growth Rate, the formula used by Medicare to calculate annual physician payment updates. The threat of steep physician payment cuts will resume in 2012 without further Congressional action. 

    What Do These Changes Mean for Your Practice?

    Medicare projected that aggregate payments to ID physicians would remain roughly unchanged in 2011. This takes into account not only the legislative payment freeze but also numerous regulatory changes that maintain payment accuracy across the Fee Schedule by adjusting the relative values of individual services.

    Local ID practices may fare better or worse depending on their patient volume, service mix, and geographic location. Generally more outpatient-focused practices or those that generate significant revenues from office-based infusion therapies (or other ancillary services) will fair slightly better in 2011. Geographic location specific reimbursement rates can be found online at the Physician Fee Schedule Search.

    View the specialty-specific impact analysis table to compare the ID specialty's Medicare payments with other specialties.

    Future Physician Payment Cuts

    Congressional passage of a 10-month payment fix means that steep cuts have been forestalled but not prevented. Physicians face several years of future payment cuts beginning with a 35 percent cut in 2013. These cuts are due to the flawed formula, the Sustainable Growth Rate (SGR), used by Medicare to calculate physician payments. For additional information regarding future payment cuts please visit IDSA’s Physician Payment Toolkit. You can use the toolkit to contact your members of Congress to urge them to find a long-term and sustainable solution to the physician-payment problem.

    Medicare Participation Options

    Due to the uncertainties surrounding future physician payment updates, IDSA has collaborated with the American Medical Association to develop a summary of Medicare participation options for physicians. This document explains what it means to be a participating physician, a non-participating physician, and a private contractor.

     

 

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