As all community oncology practices should know, a general 21.2% Medicare physician fee cut looms on March 1, 2010 unless Congress acts to avert it. The cut was supposed to go into effect on January 1, 2010 but Congress put a 2-month patch into the defense bill that was passed at the end of 2009.

Here is a brief recap on what is (likely) to happen, what you need to be aware of, and where this is (likely) heading…

The game with the sustainable growth rate (SGR) continues as the Senate has put a 7-month patch into the jobs bill. If the jobs bill is passed, then the 21.2% cut is spared from going into effect until October 1, 2010.

Here is the good news and the bad news.

The good news is that at least there is realization that the 21.2% overall Medicare payment cut needs to be averted and there is some solution to dealing with it. The bad news is that the weather has forced postponement of any discussion and vote on the jobs bill until after the Presidents’ Day weeklong recess.  That means that there will only be about 4 days for the Senate to pass the jobs bill, for the House to do the same, for any differences to be ironed out, for the President to sign a bill into law, and for the Centers for Medicare & Medicaid Services (CMS) to have their systems programmed in order to timely instruct carriers to process and pay claims.

In short, we are very concerned that at least there will be some interruption in the processing of payments, as occurred for the first two weeks or so of this year. However, the possibility does exist that the cut can go into effect March 1st unless the jobs bill passes or unless Congress takes other action. We believe any action taken after March 1st would be retroactive back to March 1st; however, all is speculation at this point.  Congress has effectively been shut down this week due to the weather.

We are not trying to alarm anyone; just prepare you for the possibility of would could occur so you can take appropriate action. Right now, it’s unclear what is worse, the weather or politics, but both are wrecking havoc with medical practice.

What is the long term strategy for the SGR and the Medicare physician fee schedule? Once again, there is good news and bad news. We do not believe there currently is any way that Congress will actually fix the broken SGR formula. We say that because it would cost well in excess of $200 billion and there is no way to pay for a true fix. We believe that Congress will put a longer-term patch in place, possibly 3-5 years. The path for this was set in place when Congress recently voted to increase the federal debt ceiling and, in the process, exempted about 5 years of an SGR patch from the requirement of paying for it. That would be good news, at least in terms of getting out of the annual patching exercise. However, the bad news is that many in Congress want to hand over control of Medicare policy to an Independent Medicare Advisory Board. This Board would do what Congress has not done; namely, allow the Medicare fee cuts to go into effect and off a cliff.

COA has weighed in with the congressional leadership and members about the increasingly devastating impact of all fee cuts to community oncology. We will continue to fight for community oncology on this general payment cut, as well as the oncology specific cuts.

How can you help? For one, spread the word about the Stop Cancer Care Cuts Petition. Go to the COA website at http://www.communityoncology.org for information and practice materials. There are close to 30,000 signers to date.

We will update you as we learn more information.