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Arthritis patients on Medicare face losing
their Rheumatologists
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 flawe
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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