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Avoiding
an estimated 31 percent pay cut for physicians from 2006
to 2012 would be "prohibitively expensive," two
influential legislators warn.
Unless
the Centers for Medicare and Medicaid Services acts to fix
the Sustainable Growth Rate (SGR) formula for physician
payment updates, Congress will be unable to avert the roughly
5 percent annual cuts over the next seven years, warn Rep.
Bill Thomas (R-CA) and Nancy Johnson (R-CT), chairs of the
House Ways & Means Committee and Health Subcommittee
respectively, in a July 12 letter to CMS.
CMS
could do two things to adjust the assumptions in the SGR,
and therefore make a rescue of physician payments appear
less expensive, say Thomas and Johnson:
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remove drugs retroactively from the SGR. Currently the
formula includes drugs provided incident to a physician
services, which have been rising much faster than other
physician services. "Drugs are not administered under
the physician fee schedule," so it's "illogical"
to include them in physicians' spending totals, the letter
chides. CMS has the authority to remove drugs from the
formula and thus reduce the need for steep cuts.
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allow for the costs of new and expanded benefits. When
CMS adds coverage for services such as PET scans for Alzheimer's
patients, cochlear implants, carotid artery stenting and
photodynamic therapy for macular degeneration, it increases
physician spending and adds to the pressure for cuts.
CMS should share its estimates of the costs of these new
coverage decisions with Congress, Thomas and Johnson insist.
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