Medicare and Government Health Care and Health Care & Life Sciences and Health Care & Insurance

Q&A: Don Stumpp

May 26, 2010

Don Stumpp, manager of payer contracting at Indianapolis-based physician group American Health Network and president of the Indiana Medical Group Management Association, discussed the impact of the health care reform law on primary-care physicians as well as the near-constant threat of a sharp cut in Medicare reimbursement.

IBJ: Congress is working this week to pass a delay to the implementation of the Medicare sustainable-growth-rate formula (SGR) to put off a 21-percent cut in physician payments. However, throughout this year, Congress has passed only 30- and 60-day delays. What has the been the impact on AHN's practices of having this potential cut looming so frequently?

A: It has been distracting. This happens every year, so we’re used to it. Everybody understands what happens. Physicians will want to know, what should I do: Should I stop taking Medicare patients, should I limit them, what do I have the right to do? In our group, there will be docs that come and ask this. Depending on what they’re thinking, they get a little more agitated and want to do something about it. But we’ve always operated under the assumption that it will get fixed.

IBJ: What would happen if the Medicare cuts went into effect? What would that force American Health Network physicians to do?

A: It seems impossible to think about what would happen. And it doesn’t look like it’s going to happen this year. Physicians would not just drop patients. They can limit their Medicare patients. Just like any business, you would start selling your services to higher payers. Access would be a problem to Medicare patients.

IBJ: How will primary-care physicians, which make up most of American Health Networks's practices, fare under the new Medicare fee schedules and the boost in primary-care Medicaid payments in the health reform law? Are these improvements significant enough to redress much of the disparity between primary-care docs and specialists?

A: It certainly does go a long way. Because the primary-care doctor relies on the office visit and [getting paid] for their cognitive skills in that office visit to ultimately keep the patient from (unnecessarily) using more health care services. Coupled with the medical home and the accountable-care organizations [two new programs created by the health reform law], primary care is going to be the front person for that. There’s clearly going to be more of a focus on them.

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