Stakeholders look for common ground on Medicare reform

Washington -- Speakers representing different camps in the debate over Medicare payment system reform urged doctors at the AMA's National Advocacy Conference to work with them toward agreement where possible, despite potentially competing interests.

Representatives from Congress, AARP, and the managed care and pharmaceutical drug industries acknowledged at last month's event in Washington, D.C., that money is tight and the demands on the payment system are intense. Physicians are pushing again this year for a Medicare fee cut reversal and government-negotiated prices for prescription drugs. But some conference participants noted that doctors are not the only ones who have a stake in the outcome of the congressional debate.

"No one will walk away from the table of Medicare reform with absolutely everything that they want," said Kirsten Sloan, AARP's chief health lobbyist. The group remains concerned about Congress boosting reimbursements to physicians because beneficiary premiums would rise as a result unless lawmakers implemented Medicare cuts elsewhere.

Sloan and other participants called on doctors to work with senior groups toward consensus by starting in areas where they already have agreement. Promoting more health information technology and evidence-based clinical research, for instance, could help address some existing problems without major financing reform, she said.

Billy Tauzin, a former congressman who is now president and CEO of the Pharmaceutical Research and Manufacturers of America, said doctors and drug firms could put aside differences to continue educating seniors about Medicare Part D. But while both the AMA and AARP support giving the federal government the ability to negotiate Medicare drug prices directly with manufacturers, PhRMA continues vigorously to oppose such a move.

Keeping costs down through coordinating care and steering patients toward more effective treatments is something on which physicians and managed care companies can agree, said Karen Ignagni, president and CEO of America's Health Insurance Plans. But she defended payment rates for Medicare Advantage plans, which by some estimates are receiving average reimbursements that are significantly higher than fee-for-service payments.

AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, said physicians would need to help reconcile the desire to give every patient as much care as possible with the fact that a finite amount of health care funding exists. Several lawmakers at the conference also made the point about limited resources. While physicians believe enough money exists in government coffers now to help both doctors and patients, future medical advances and rising health care costs could force increasingly tougher choices about how to assign value to health care and when to pay for it.

"That may actually be the ethical question when we examine health care, particularly for the next 20 to 30 years," Dr. Maves said.