AMA House of Delegates

AMA President Cecil B. Wilson, MD, minced no words on what action is needed to fix Medicare payment. "The priority is to eliminate the SGR," he told delegates during the opening session of the Interim Meeting on Nov. 6. "Toss it overboard. Drown that sucker." Photo by Ted Grudzinski / AMA

AMA meeting: Association spotlights need for Medicare payment reform

With drastic cuts on the horizon, AMA leaders focused on efforts to get a 13-month physician pay patch.

By Victoria Stagg Elliott — Posted Nov. 22, 2010

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Now that the lame-duck Congress is back in session, the American Medical Association has intensified efforts to prevent a 25% reduction in Medicare physician pay.

The week before Congress convened, the AMA made Medicare pay a focal point of the Association's Interim Meeting Nov. 6-9. In his opening-session speech to the meeting of the House of Delegates, AMA President Cecil B. Wilson, MD, said the AMA would work with congressional leaders to stabilize Medicare pay for physicians at least through 2011. Delegates were urged to contact lawmakers and remind them of the impact the cut would have on seniors.

The AMA placed a full-page ad on Nov. 8 in USA Today, urging Congress to act. The same day, Dr. Wilson held a news conference and discussed the catastrophic effect the pay reduction would have on those who rely on Medicare. He also gave details of an AMA survey of 1,000 adults showing that 94% believe the looming cut poses a serious problem for seniors.

The hope is that the heightened attention will move Congress to prevent the pay cut.

"Everyone in Congress knows that this cut will cause problems for seniors, and the AMA is working to turn that concern into action before time runs out,"Dr. Wilson said.

Physicians are in store for a 25% reduction in Medicare payments through the end of the year, according to the final 2011 physician fee schedule released Nov. 2 by the Centers for Medicare & Medicaid Services. Pay is scheduled to go down 23% on Dec. 1 and an additional 2% on Jan. 1, 2011.

The AMA and other medical organizations say the 13-month patch will provide short-term stability, and give organized medicine and Congress time to craft a permanent solution to the sustainable growth rate formula.

Repealing the SGR is the ultimate goal, but physicians say a pay patch is the most feasible option with the lame-duck Congress and the many new lawmakers set to take office Jan. 3, 2011.

"Unless Congress takes quick action to prevent the cut before they go home for Thanksgiving and preserve seniors' access to needed health care services and prevent a Medicare meltdown, this will be catastrophic," Dr. Wilson said during his news conference at the Interim Meeting.

Support for pay patch

Physicians are finding support among some government officials and the public. According to the AMA survey, 81% of adults feel that Congress should act immediately to prevent the pay cut.

"Americans 65 and over have earned their Medicare and the right to keep seeing the doctors they count on," said AARP Board Member Mara Mayor, PhD. "Congress has a responsibility to keep doctors in the Medicare program. It's time for politicians to come together to stop these cuts so seniors can have the peace of mind they've earned."

Senate Majority Leader Harry Reid (D, Nev.) said he intends to get the issue on the legislative calendar for the lame-duck session. Dept. of Health and Human Services Secretary Kathleen Sebelius said cuts should not be allowed to go forward, and that President Obama said during a Cabinet meeting that "preventing these potentially disastrous cuts must be one of our top priorities."

"I hope that Congress will act quickly to pass [the 13-month patch], so that our doctors and seniors can have some peace of mind while we work on a long-term fix," Sebelius said in a Nov. 8 speech to the Assn. of American Medical Colleges.

The impending cut also affects those covered by Tricare, the insurance program for members of the military, retirees and their dependents. The AMA issued a joint statement with the Military Officers Assn. of America calling on Congress to act.

"This payment cut is the No. 1 threat to military beneficiaries' health care access," said MOAA President Vice Adm. Norb Ryan Jr., who is retired from the Navy. "The last thing our deployed service members should have to worry about is whether their sick spouse or child will be denied an appointment by their doctor."

The pay patch will cost an estimated $17 billion. The two co-chairs of the National Commission on Fiscal Responsibility and Reform, a bipartisan body appointed by President Obama, on Nov. 10 issued recommendations for reducing the deficit by $4 trillion through 2020, including scrapping the SGR but still having physicians take modest reductions in Medicare pay. The full commission has yet to act.

"Medicare pays less than the cost of doing business and less than the cost of taking care of patients right now," said AMA Board of Trustees Member Barbara L. McAneny, MD. "CMS needs to recognize that it needs to cover the cost of providing the service and give the physician a margin for bad debt. Every business has to have a margin or they don't survive. You cannot balance the budget by having physicians cost-shift to private health insurers."

Many physicians say their practices will struggle to survive financially if the pay reduction is imposed, and doctors will be forced to limit Medicare patients. "Cuts are pending at a time when our physicians will be deciding whether to opt in or opt out of Medicare," said Michael A. Wasylik, MD, a delegate for the Florida Medical Assn. and an orthopedic surgeon in Tampa. "If they opt out, we are going to have an access problem. If they opt in and cut back on the amount of Medicare patients they will see, we also have an access problem."

At the Interim Meeting, delegates took action addressing Medicare payment reform, including approving a policy that calls for the AMA to pursue a campaign for legislation that would allow Medicare patients to contract privately with physicians.

But the focus remains on averting the pay cut and repealing the SGR, even as the AMA launches a new wave of newspaper ads in Washington, D.C., to get the attention of Congress.

"Congressional action this month is the only way to stop the Medicare cut," Dr. Wilson said. "Congress needs to keep Medicare strong for our senior patients and ensure that baby boomers will have access to physicians when they begin receiving their Medicare cards for the first time this January."

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Meeting notes: Legislative actions

Issue: The National Health Services Corps scholarship program encourages primary care physicians to practice in underserved areas, but the program is still underutilized. The Patient Protection and Affordable Care Act will expand it by $1.5 billion during the next five years.

Proposed action: Work to increase physician, medical school and medical student representation in the decision-making process of the program to help make it more popular and more efficient. [Adopted]

Issue: Debt incurred by patients for health care is far less predictable and more complex than most consumer debt, but it can impact financial health significantly. In addition, consumers looking to improve credit scores would be more likely to pay off medical debt first if these amounts were cleared from their records within 30 days rather than the usual seven years.

Proposed action: Support the principles that are stated in the Medical Debt Relief Act, which passed the House on Sept. 29 and has been referred to the Senate. [Adopted]

Issue: The Patient Protection and Affordable Care Act requires companies offering group and individual health insurance with dependent coverage to continue offering this until the child is 26. The law does not apply to those covered by Tricare.

Proposed action: Support legislation providing coverage of military children under Tricare in line with that offered by private health plans. [Adopted]

Issue: The Patient Protection and Affordable Care Act is a flawed piece of legislation that did not sufficiently address medical liability reform, the sustainable growth rate and problems with antitrust rules.

Proposed action: Identify flaws in PPACA and advocate that they be fixed. [Adopted]

Issue: Hospitals declaring bankruptcy that do not pay for "tail coverage" leave physicians personally liable for any claims made after the institution closes.

Proposed action: Seek federal legislation amending the bankruptcy code such that medical liability premiums paid for physician employees will be considered a priority claim and paid immediately out of the proceeds of a bankrupt hospital's estate. [Adopted]

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