SGR (sustainable growth rate) is a complex formula tied to the United States economy that determines the rates paid to physicians (including psychologists) under Medicare. Each year, for at least the last 10 years, the SGR resulted in cuts to physician fees. Fifteen times congress has postponed the cuts. These cuts do not dissolve once they are postponed; they become cumulative and need to be addressed again each fiscal year.
As of January 1, 2014, we were due for a 24% SGR cut, but congress delayed the cut for three months to allow more time to consider the options. For the first time, there are bills in Congress addressing the fundamental SGR formula within Medicare law. Changing Medicare law is the only permanent way to stop the automatic SGR cuts.
In addition to postponing SGR cuts for three months, congress gave an across the board increase of 0.5% to physician fees. Psychologists were instrumental in contacting their congress persons asking them to postpone the SGR cuts. Grass roots efforts really do work.
I’d like to feel excited about the 0.5% increase and 24% SGR postponement, but it is difficult to feel excited when fee cuts occur more often than increases. We still have the 2% across the board sequestration cut to contend with (starting 1/1/14) and the recent fee cuts to initial evaluations and other codes. It has been a difficult year with regard to Medicare reimbursement.
Since we have a new diagnostic manual, I’d like to propose a new diagnostic code: Medicare Dysphoric Disorder. I haven’t yet decided whether it should be classified with the mood disorders or the stress disorders. If you think you have this disorder, the only cure is to write to your congress persons encouraging them to continue to postpone the SGR cut and develop a permanent fix to the flawed SGR formula.
WPA Advocacy Cabinet
(Post Author: Dori Ann Bischmann, PhD)