Government
Effort to stop Medicare cuts hits 11th hour
■ Hundreds of doctors called their lawmakers, and the AMA ran an ad in two of the nation's largest newspapers as an open letter to patients.
By Damon Adams — Posted Dec. 4, 2006
- INTERIM MEETING 2006
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Las Vegas -- The AMA House of Delegates reached across the country and spoke to congressional leaders in a year-end campaign to avoid a 5% Medicare physician payment reduction set for Jan. 1, 2007.
During the Interim Meeting last month, delegates gathered early one day so they could act as a single voice, calling lawmakers from their cell phones. The physicians urged their U.S. representatives and senators to act in the lame-duck session, stop the payment cut and provide a positive 2007 update to reflect increases in practice costs.
More than 550 calls were made in 20 minutes. Delegates also sent 457 e-mails and faxes to elected officials.
"This is a great start," said AMA house Speaker Nancy H. Nielsen, MD, PhD, an internist from Buffalo, N.Y.
The AMA campaign also included a full-page ad that ran Nov. 15 in USA Today and The Washington Post. The ad was an open letter signed by physicians asking patients to tell Congress to take action and stop Medicare payment cuts.
Meanwhile, the AMA Board of Trustees issued an informational report during the meeting to raise awareness and spell out proposed remedies. The document calls on Congress to provide a positive payment update and to include provisions to facilitate a long-term solution.
"There is absolutely no valid reason for them to avoid action on this issue before the end of this session," AMA President William G. Plested III, MD, told AMA delegates in his speech.
"Unfortunately, the campaign to avoid the 5% cut next January only addresses the immediate result of the ongoing [sustainable growth rate] saga because [the Centers for Medicare & Medicaid Services] has promised cuts well into the future," he added. "These cuts will occur year after year after year for the next nine years, and will total at least 40%. Also, during this time period, the costs of opening our offices each day will rise by at least 30%."
Delegates considered a resolution that called for the AMA to organize a nationwide week of awareness to educate the public about the issue. The program would feature a "fly-in" of physicians to Washington, D.C.
While some delegates liked the idea, others voiced concerns about the event costs, estimated at $855,000; potential legal issues regarding coverage for patients; and the feasibility of a fly-in. Delegates voted to refer the proposal to the board for decision.
Also at the meeting, physicians got a chance to pose questions to Health and Human Services Secretary Michael Leavitt, the keynote speaker at the opening session. They asked him if it would take a crisis to eliminate the SGR formula that is responsible for the upcoming reductions. Leavitt acknowledged the cut "is a problem for physicians, and frankly it is a problem for HHS."
On one extreme, it would take more than $200 billion from Congress to address the long-term payment problems. On the other extreme, physicians will stop taking Medicare patients if the system isn't fixed, he said.
Leavitt said there needs to be a third way to address the problem. "Likely, physicians will be reimbursed not only on quantity, but on the quality of care."
Leavitt noted the quality measurement system is not fully developed but said there needs to be a system to measure performance and reward higher quality and lower costs.
"I believe it is the political reality," he said.
Time running out
In Washington, meanwhile, Congress recessed for the Thanksgiving holiday without accomplishing much in its first week of the lame-duck session other than electing party leaders. Lawmakers return the week of Dec. 4, but congressional aides said it was looking increasingly unlikely that Congress would fully address the 2007 cut before it takes effect.
The problem lies in finding the more than $10 billion over five years that would be necessary even to freeze physician rates at 2006 levels. With the upcoming shift in power and the Republican party on Capitol Hill in disarray, as some describe it, GOP leaders might not find the time to correct the problem.
Before both houses recessed for Thanksgiving, some Republican aides floated a proposal to delay the 5% cut for at least six months. Such a move would decrease the cost associated with a temporary adjustment but would require the Democratic Congress to revisit the issue next year. At that time, lawmakers also would be dealing with the prospect of a cut of similar size for 2008.
Legislation for either a six-month or a year-long solution also would open the door to other health care professionals, such as rehabilitation therapists, who are hoping to boost their Medicare rates next year and who might see the physician measure as a good vehicle for such a proposal.
If Jan. 1 arrives without lawmakers acting, the cut will take effect and the pressure will be on the new Congress to adjust physician pay retroactively. While doctors under such a situation could eventually be made financially whole, they would receive lower rates until President Bush signed the legislation into law.
AMA board Chair Cecil B. Wilson, MD, an internist from Winter Park, Fla., said Congress will not have fulfilled its duty to Medicare patients if it waits until next year to address a situation that requires action now. "To have Congress put this off is not a responsible way to govern."
Tanya Albert Henry contributed to this report.