Newswise — Rheumatologists who treat the nearly 46 million patients with arthritis and other rheumatic diseases across the United States are faced with the possibility of closing their doors to Medicare patients, according to the American College of Rheumatology.
The Sustainable Growth Rate is part of the formula used to calculate Medicare payments to physicians. Unfortunately, the formula is flawed. The SGR formula is linked to the performance of the overall economy, yet the medical needs of individual patients do not shrink whenever the economy slows. When overall spending on services in the SGR exceeds the rate of change in the per capita gross domestic product, cuts to physician reimbursement are triggered.
Congress oversees the Medicare program, including how physicians are reimbursed for the cost of caring for patients. For several years, Congress has agreed that the system under which physicians are reimbursed is no longer working—but it has not fixed it.
The SGR also includes the costs of drugs covered under Medicare Part B, a cost over which physicians have no control. Spending on these Part B drugs is increasing at a higher rate than spending on actual physician services. This skews the calculation of the SGR and triggers unsustainable reductions in physician reimbursement.
"It costs a rheumatologist a certain amount of money each year to stay in practice," says ACR President, David A. Fox, MD. "This isn't about physicians wanting more money, it is simple arithmetic. While physician payments drop, physician costs continue to increase. The outcome is inevitable—without fundamental change, rheumatologists will be forced to start closing their doors to patients on Medicare, and these patients will be without care. Unfortunately, some rheumatologists have already been forced to take this step, or even close their practices entirely."
Cuts to the SGR will affect all physicians, not just rheumatologists—therefore affecting the majority of the 40 million Americans currently covered by Medicare. Congress has intermittently applied bandages to the problem, but without a long-term resolution, millions of Americans will be left with no one to treat them.
"There is already an alarming access-to-care issue in rheumatology," explains Dr. Fox. "In many areas, patients are being forced to wait weeks—if not months—on average before they can see a rheumatologist, yet we know that early intervention is important for successful treatment of serious rheumatic diseases, such as rheumatoid arthritis and lupus. Without prompt attention, the Medicare reimbursement crisis, caused largely by the flawed SGR formula is certain to aggravate the existing serious shortage of rheumatologists in the United States."
Members and staff of the ACR are meeting with lawmakers on Capitol Hill on February 26 to discuss the crisis facing rheumatology patients, and the absolute need to ensure that Medicare patients are not turned away from practices that can no longer afford to see them.
The ACR asks rheumatologists, health care professionals and the patients they treat to contact Congress, through The ACR legislative action center, http://www.capwiz.com/acr, to urge their representatives to take the crisis facing the millions of Medicare patients seriously—fix the SGR and ensure a healthy future for all Americans.
About The American College of Rheumatology
The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases.
The American College of Rheumatology, founded in 1934, is the largest professional organization of physicians, scientists, and health professionals devoted to the study and treatment of the rheumatic diseases. ACR members maintain a strong commitment to research and education, advancing the understanding of the rheumatic diseases, and discovering new therapies to treat these diseases.
The American College of Rheumatology can be found online at http://www.rheumatology.org.
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