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Posted by on May 25, 2010 in Health care, Legislation

Proposed Amendment to Medicare Reimbursement Explained, Sort Of

Proposed Amendment to Medicare Reimbursement Explained, Sort Of


More from Medscape’s Rob Lowes on the House amendment to alter Medicare reimbursement rates.

If the bill, American Jobs and Closing Tax Loopholes Act, in its present form passes, Medicare reimbursement will actually increase by 1.3% for the rest of this year; in 2011, another reimbursement increase of 1% will take place.* Then a confusing purgatory emerges, as the reimbursement rates for 2012 and 2013 are determined by using “a complicated formula that favors primary care physicians,” Lowes writes; but, he also maintains, reimbursement rates would not decline.

According to Sec. 523 of the amendment text, “separate conversion factors” (which, by my reading, are 0.02 or 0.01, with a reference rate established on June 1st of this year) will be used to determine reimbursement for “each service category of physicians’ services.” I’m inferring that these service categories are defined in the original bill and that, per Lowes’s reporting, they favor primary care services.

Then, after a short reign of confusion, a great hellish maw of earth known as Restored Legislation sends most physicians** to the 9th circle of “Why bother?” In 2014, the SGR formula for calculating Medicare rates kicks back in with a time-sensitive vengeance, demanding a precipitous drop in reimbursementsomewhere in the neighborhood of 30% or more.

Lowes also reports that Congress will hold votes on the bill before the upcoming Memorial Day weekend.

* But these rate increases, Lowes reports, are well below the expected annual inflation rates (between 2% and 3%).

** According to Lowes, via the Center for Studying Health System Change, about 30% of physician revenue is derived from Medicare. For internists, the percentage exceeds 40%.

Photo of weathered can from magannie at Flickr.

bmartin (1127 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.