Medicare in Texas isn’t looking good right now. Texas Physicians are not in a good mood since the U.S. Congress plans on cutting their payments by 29.4% once the Cliff legislation method expires on January, 2012. For the past decade, Medicare funding has been on a high which is more than the funding formula of the U.S. government allows. To get back the excess funds given to the federal health insurance for the elderly, payments to the doctors of Medicare are cut to a certain percentage. A lot of money is used to effectively provide health care to the elderly and to those who have disabilities.
Though the payment cut that is resorted to came from a good and just reason, Doctors and Physicians of Medicare in Texas believe that the health care of the elderly and of those with disabilities will be greatly affected. These professionals that tend to the health care needs think that the planned heavy and deep cut to their payments by 2012 is very devastating to them as well. To control costs, there is a Medicare funding formula that lawmakers use as their basis for giving out the Medicare funds. The formula’s calculation depends on the Medicare enrollment annually, the Medicare cost from the previous year, and the changing cost of inflation. By weighing the three factors of the funding formula, lawmakers are able to set a target limit of funding every year.
The physicians are paid for the different and important services that they have rendered in accordance to the target funding limit of the current year. If funding exceeds the target fund limit, the payments of the Doctors and Physicians are reduced through subsequent years to get back the excess in funding of the previous ones. The first time that the there was an excess in the target fund limit happened in 2001 where lawmakers deducted 4.8% from the payments of physicians. All the subsequent years all had excess in the Medicare target fund limit. To keep the Doctors and Physicians continue helping the elderly and those with disabilities and avoid these health care professionals from opting out, accepting fewer patients, and provide lesser services to the Medicare members, the U.S. Congress has repeatedly overwritten the rate reduction requirements for the health care professionals.
The Clawback and the Cliff are legislative methods used for delaying the reduction of the payments of the Doctors and Physicians. The Clawback increased payment rates for a short period of time but then reduced them by the maximum allowable amount indicated in the current funding formula for Medicare for the succeeding years. The Clawback was only used for in 2004 and 2006 and expired in 2007. Since lawmakers knew that using Clawback again would mean extending the time period to get back the cost beyond a 10-year budget window, they use the Cliff method instead in 2007 up to the present. Doctors and Physicians’ payments will only be reduced expires below the maximum amount allowable under the Medicare only after the legislation method has expired.
Since it has been used for 5 consecutive times by 2012, the payment rates of the health care professionals will drop below the 2007 payment rates or exactly 29.4%. This amount of reduction is very deep and hurtful to Doctors and Physicians. Medicare in Texas looks to take a curved road in servicing the elderly because surveys and studies show that only 33% of the Texas Doctors and Physicians will accept Medicare patients if the planned payment cut is approved. More than 50% considered opting out while 10% have decided to opt out immediately when the cut happens. Both the sides of the patients and the health care professionals have expenses to cover and there is no easy answer on how the government will get back the excess cost that they have incurred for Medicare in the past.Time will only tell whether there will be a new formula beneficial to all the sides affected by the payment reduction or elderly people just won’t be attended to effectively anymore in the future especially in Texas.
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