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Casi una mitad de cirujanos podría optar fuera de Seguro de enfermedad si el arreglo de SGR falla

por Brendon Nafziger, DOTmed News Associate Editor | March 30, 2010
Surgeons bemoan
Medicare pay mess
Almost a third of general surgeons say they will opt out of participating in Medicare for at least two years, according to a new survey, as a 21 percent cut in Medicare reimbursements is set to go into effect April 1.

The survey of around 13,000 physicians was released Thursday by the Surgical Coalition, an alliance made up of the American College of Surgeons and 22 other medical groups.

Nearly 29 percent of general surgeons and anesthesiologists say they will opt out of Medicare for at least the two years required under Medicare law and work with patients privately to determine the cost of services. A further 69 percent say they will trim the number of appointments with those on Medicare should the pay cuts go through.

The Surgical Coalition blames the opting out on what they see as a "flawed" method for calculating what physicians are paid through Medicare, known as the sustainable growth rate (SGR) formula.

"The formula contains administrative errors and fails to accurately reflect the costs of sustaining medical practices," the Surgical Coalition said in a statement.

"Significant shift"

Even if only a small number of surgeons saying they will opt out of Medicare actually do it, it will represent a "significant shift" in the words of Katie Orrico, director of the American Association of Neurological Surgeons, a member of the Surgical Coalition.

"It will [transform] what has typically been a fairly rare occurrence - clearly less than 2 percent of physicians currently now actively opt out of Medicare," Orrico tells DOTmed News.

And although nearly one-third of general surgeons (31 percent) say they will continue to fully participate with Medicare, they expect to make drastic changes in their practices. Almost half say pay cuts will force them to lay off staff and shorten time spent with Medicare patients. And about one in 20 say they will retire.

"I work in [a] rural area and this will force me to close," moans one orthopedic surgeon quoted in the Surgical Coalition report.

Many more also say they will refer their most complex cases - which are also the most time-consuming - to academic teaching hospitals. This and the reduction in appointments for Medicare patients could result in longer wait times for treatment, says Orrico.

And a plurality of surgeons, around forty percent, while working with Medicare, say they will switch to "non-participating" status, which gives them slightly more freedom to set rates for Medicare patients, but at the cost of more billing headaches. Unlike for participating doctors, Medicare reimburses the patients directly, not the physicians, so doctors have to dun their patients to get paid.