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Posted: 9:28 p.m. Friday, Dec. 28, 2012

Fiscal cliff effect on health care

Medicare provider payments could be cut by nearly 30 percent

By Randy Tucker

Medicare provider payments will be cut by nearly 30 percent on Tuesday that would affect nearly 2 million beneficiaries in Ohio, most of them elderly.

The cuts stem from Medicare’s sustainable growth rate formula, which was established to keep payments to doctors under control. But the formula routinely cuts too deep for doctors to continue providing care, so Congress each year since 2003 has passed a so-called “doc-fix” to fill the gap.

Obama has proposed eliminating the growth rate formula as part of his plan to avoid the fiscal cliff, but no deal is imminent.

That means Medicare payments would be cut by 27 percent beginning Monday on top of a 2 percent reduction called for in sequestration.

“It’ll just end up restricting access for Medicare patients,” said Baird of the Dayton Physicians Network. “We would have to try to change our patient mix and extend those Medicare visits out farther…so it might take a lot longer time to get an appointment.”

In past years, the Centers for Medicare & Medicaid Services has delayed processing claims until Congress took action to avoid significant cuts.

Even if that were to happen this year, it would not offer much relief to the Dayton network’s 36 members and their Medicare patients, which comprise about half of the practice’s clients, Baird said.

“Being an oncology practice, we do a lot of high-cost procedures that cost us a lot of money, so it’s important that we maintain our cash flow,” Baird said. “So even if Medicare was to delay it (payment cuts) by two weeks…it would still result in a huge cost increase for us and a decrease in our cash flow.

“If this were to go on for an extended period, we would have to try to change our patient mix and look at limiting the number of Medicare patients we could take,” he said. “And if it gets really severe, we would have to look at our business and determine if we would be able to do anything with salary, staff and any of the locations we have.”

Read more about those in jeopardy in Ohio:

Fiscal cliff effect on local:   Agriculture  |  Health care  |  National security  | Local/state governments  |  Jobless benefits  |  Financial markets  |  K-12 education  | Colleges and universities

Read more about the fiscal cliff:              

               Your opinion: Who's to blame for no solutions?

               With "cliff" solved, taxes to increase in 2013

               Over the fiscal cliff: Soft or hard landing?

               What exactly is the fiscal cliff?    

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