Doctors vote to fight Medicare imaging cuts and audit project

Chicago -- In a show of solidarity, physician delegates from the American Medical Association last month voted to actively oppose two elements of the Medicare system that so far have unfairly impacted only a minority of doctors.

The AMA will work with Congress to rescind Medicare's recovery audit contractor program, under which private firms comb through physician claims data to find instances in which the federal government overpaid doctors and to recoup those dollars. In a separate action at the Annual Meeting, the House of Delegates also decided to support the repeal or delay of medical imaging cuts that are due to start in January 2007.

The audit program is currently operating in three states over the course of a three-year pilot test that began in 2005. The Medicare imaging cuts will affect only physicians who offer such services in their offices and whose reimbursement for the technical portion of the scans currently exceeds what hospital outpatient departments receive for the same services.

But affected physicians argued in both cases that all doctors should be worried about where such relatively small steps could lead.

"This year, [lawmakers] may make further arbitrary cuts on any other method of care that they want," said John Seibel, MD, a delegate from the American Assn. of Clinical Endocrinologists, who spoke out against the imaging cuts. "This is not just affecting imaging. It may affect your services."

Troy Tippett, MD, a neurological surgeon and delegate from Florida, had a similar warning for the physician community as a whole about the recovery audits, which are operating in his state, New York and California.

"They are looking again at all of your charts and trying to figure out if they can not pay you," he said. "If it works in our states -- which means if they suck the bone dry -- they will then put it in your state."

In both cases, the AMA reference committee reviewing testimony on the resolutions recommended that they be referred to the Association's board for further study and a possible decision later in the year. Supporters of such a referral said that the Association instead should focus on comprehensive Medicare payment reforms that would benefit all physicians.

Delegates decided against this advice, however, forcing votes on the floor that resulted in the new AMA directives.

Physicians testifying about the imaging cuts and the audits struck a similar theme, decrying the efforts as onerous and arbitrary attempts to squeeze Medicare dollars out of physician offices.

Cost cutting and bounty hunting

Dennis Agliano, MD, a delegate and Tampa, Fla., otolaryngologist, said physicians in his state had reported receiving letters from recovery auditors demanding justification for legitimate Medicare claims and repayment of reimbursements that were deemed too high. Although the contractors are supposed to be identifying cases in which physicians were underpaid as well as those in which they were overpaid by Medicare, no doctor has reported receiving any additional payments as a result of this process, he said.

The situation has physicians such as Dr. Agliano referring to the audit firms as "bounty hunters" or "henchmen." Several delegates who have had experience with the program said that a strong level of AMA opposition -- even if it does not succeed in stopping the three-year pilot -- is needed to prevent federal officials from expanding the program to other states or making it more permanent.

Congress also could decide to extend rate reductions to other types of services based on the success of the imaging cuts, which could reduce technical payments for some scans by 40% or more, Dr. Seibel said. Legislators added the cuts without public debate to a deficit reduction bill that was enacted in February, leaving radiologists and other physicians who perform the tests in their offices scrambling to avert payment changes that are already written into law and that will take effect in mere months.

Daniel Johnson, MD, a former AMA president and a delegate from the American College of Radiology, proposed adding language seeking the delay of the cuts if a repeal is not possible. He and other doctors concluded that a total reversal of the reductions would be a tough sell on Capitol Hill in the remaining months of the year.

Showing physicians the way out

Physicians frustrated with such declining payments and heightened administrative burdens in Medicare called for the AMA to provide doctors with information about how to leave all of that behind by getting out of the program altogether.

But delegates balked at a resolution that would have placed Medicare opt-out instructions in a prominent place on the Association's main Web site as well as in a dedicated e-mail to members. The house instead approved a more limited version of the measure that will place a link to the instructions in the members-only section of the Web site.

Physicians who argued against the more accessible display said the AMA could give the impression it is advocating that doctors drop out of the program, effectively souring relations with legislators whom the Association is lobbying for comprehensive Medicare payment reforms.

"There is some concern that placing this too prominently on our Web site could give a black eye to the AMA," said internist Richard Whitten, MD, a delegate from Washington and the chair of the reference committee that came up with the final language.

Not every delegate agreed with this sentiment. The original language of the resolution failed on a full house vote that was nearly 50-50.