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Medicare pay struggle a familiar year-end cliffhanger

Physician organizations are working toward a permanent plan to bring payment stability and higher quality to Medicare, but they have run into a familiar roadblock on Capitol Hill — impending deep payment cuts and no immediate relief in sight. Doctors participating in Medicare again found themselves just days away from a large decrease in pay rates, with Congress working against the clock to craft another temporary solution. At this article’s deadline, no deal had been reached to stop a 26.5% cut under the sustainable growth rate formula even as lawmakers pledged to prevent the decrease before it hits on Jan. 1, 2013. Congress has enacted stopgap legislation to prevent statutory reductions since the last cut took place in 2002. Some pay patches lasting a matter of weeks or a few months have been enacted — and applied retroactively — days or weeks after the cuts technically had taken effect. Virtually no one believes Congress will allow the SGR to lower pay in 2013, but doc ...

CMS innovation center faulted for wasteful duplication

Government investigators report that there appears to be overlap between agencies overseeing health programs and the relatively new Center for Medicare & Medicaid Innovation. The Government Accountability Office found instances in which similar multimillion-dollar programs exist in the Obama administration and urged in a report published on Dec. 21, 2012, that they be coordinated better. The Dept. of Health and Human Services, which oversees the innovation center, has championed the testing of new health care payment and delivery models that could lower federal health spending in the Medicare and Medicaid programs. GAO reviewed the innovation center’s funding and organization as of March 31, 2012. The report detailed the center’s plans for evaluating new models and examined whether there is overlap with activities by the Centers for Medicare & Medicaid Services. The innovation center had hired 184 employees to work in four groups overseeing the testing of 17 models designe ...

Medicaid primary care pay at risk in lame-duck talks

Organized medicine reacted with strong opposition to indications that Congress might eliminate a temporary Medicaid pay increase to primary care physicians as lawmakers deliberate in year-end negotiations on outstanding fiscal issues. In a series of letters to House and Senate leaders on Dec. 5, more than 250 physician associations and state medical societies urged lawmakers to oppose any proposals to eliminate the Affordable Care Act provision that boosts Medicaid primary care rates to Medicare levels in 2013 and 2014. Doing away with the primary care parity policy “further burdens the already challenged Medicaid system of today,” the physician organizations wrote. The letters don’t specify the rationale behind the possible elimination of the pay bump. But some of the signatories said Republican lawmakers were eyeing the move as a way to help pay for preventing a 26.5% Medicare doctor pay cut under the sustainable growth rate formula, or as a general offset for avoiding el ...