As if things weren't complicated enough, doctors keep facing their own recurring fiscal cliff, separate from the bigger budget battle but embroiled in it nonetheless.
Come Jan. 1, doctors and certain other medical professionals face a 26.5 percent cut in their Medicare payments, the consequence of a 1990s deficit-reduction law gone awry. Lawmakers failed to repeal or replace that law even after it became obvious that it wasn't working. Instead, Congress usually passes a "doc fix" each year to waive the cuts.
This year, the fix got hung up in larger budget politics. Although a reprieve is expected sooner or later, doctors don't like being told to sit in the congressional waiting room.
"It seems like there is a presumption that physicians and patients can basically tolerate this kind of uncertainty while the Congress goes through whatever political machinations they are going through," said Dr. Jeremy Lazarus, president of the American Medical Association. "Our concern is that physician uncertainty and anxiety about being able to pay the bills will have an impact on taking care of patients."
A recent government survey indicates that Medicare beneficiaries are having more problems when trying to find a new primary care doctor, and Lazarus said that will only get worse.
Adding to their unease, doctors also face an additional reduction if automatic spending cuts go through. Those would be triggered if Obama and congressional leaders are unable to bridge partisan differences and strike a deal. They are part of the combination of tax increases and spending cuts dubbed the "fiscal cliff."
Medicare service providers would get hit with a 2 percent across-the-board cut, but Medicaid and subsidies for the uninsured under Obama's health care overhaul would be spared. The Medicare cut adds up to about $120 billion over ten years, with 40 percent falling on hospitals, according to Avalare's analysis. Nursing homes, Medicare Advantage plans and home health agencies also get hit.