MedPAC wants to undo doctor payment system, lower rates to them and other providers

SNFs could see 50% payment reduction for Pre-Existing Condition Insurance Plan claims

A chief Medicare advisory committee has recommended that Congress repeal a 10-year-old physician reimbursement system and then reduce payments to specialists and other healthcare providers to pay for the change.

The Medicare Payment Advisory Commission made the recommendation to freeze most primary care physicians' reimbursement rates despite intense lobbying from more than 40 healthcare stakeholders. To cover the costs of foregoing the Sustainable Growth Rate (SGR) system, the panel recommended cuts to pharmaceutical companies, beneficiaries, hospitals and durable medical equipment vendors over 10 years, according to MedPAC's draft recommendations.

Without any intervention, a nearly 30% cut in payments for physicians and other Part B providers will go into effect Jan. 1.

The recommendations provoked outcry from provider groups that warned of unintended harm to Medicare enrollees. According to a statement from the American Medical Association, the plan would “leave many physicians unable to care for Medicare patients or make the investments needed to participate in new models of care that can increase coordination and reduce costs.”

MedPAC is an advisory body to Congress. Its recommendations can be bypassed or ignored by lawmakers — and often are.