BY J. MICHAEL BRODIE
The 2003 legislative year, a tumultuous one for family physicians, concluded with a Thanksgiving win. The House and Senate approved sweeping Medicare changes, including a new prescription drug benefit for older and disabled Americans and an increase in Medicare reimbursement for physicians. President Bush signed the bill Dec. 8.
The compromise legislation combines drug coverage for all Medicare beneficiaries -- long sought by Democrats -- with a Republican-backed plan to expand the role of private insurance companies for Medicare beneficiaries.
Physicians and Medicare patients won a reprieve protecting patients' access to care: The new law replaces what would have been a 4.5 percent Medicare physician fee cut in 2004 with increases of 1.5 percent in both 2004 and 2005.
For several years, the Academy and its members have fought for fairness in Medicare reimbursement. In October 2001, it became clear Medicare fees would plummet 5.4 percent in 2002. Between Nov. 1, 2001, and Feb. 3, 2003, FPs, patients and chapter executives sent 15,103 e-mails asking Congress to correct the Medicare fee formula. From Feb. 3 to Nov. 26 of 2003, another 2,622 family physicians sent e-mails asking Congress to fix the flawed Medicare reimbursement formula, and 323 patients sent similar e-mails.
Leaders laud new law
AAFP President Michael Fleming, M.D., of Shreveport, La., commended Congress for listening to the "thousands of family physicians who wrote, visited and called their elected officials" concerning the Medicare bill.
"Congress has taken the important first step in the right direction toward full support of seniors' access to effective medications under the Medicare program," said Fleming. "This is the first time since Medicare began 38 years ago that a general benefit has been added to the program."
Douglas Henley, M.D., the Academy's EVP, said it was correct for the Academy to support the Medicare legislation. "It contains the only legislative 'fix' to the anticipated decrease in Medicare fees and (marks) a commitment by Congress to review, and hopefully correct, the flawed formula."
Commenting on provisions to ease prescription costs for seniors, Henley said the law would "begin the slow pressure to introduce a formulary for Medicare -- that will have to occur to control costs over time."
Law addresses many issues
The new law temporarily blocks a Centers for Medicare & Medicaid Services rule that would have canceled payments to hospitals for residency training in nonhospital settings using volunteer teachers -- a block endorsed by the Academy. The law also requires HHS to develop transmission standards that will make general e-prescribing possible and then requires anyone who chooses to prescribe electronically to use those standards once they are promulgated.
Finally, chalk up two more wins for FPs and patients in rural and underserved communities. The law allocates a $1 billion increase in funding to reduce geographic payment disparities for services in rural and underserved areas. It also commits $700 million in incentives to encourage physicians to work in those areas.
Some bills still pending
At press time, House and Senate leaders had reached a tentative agreement on an omnibus appropriations bill that includes Section 747 of Title VII of the Public Health Service Act. This section calls for funds for training in family medicine, other primary care areas and dentistry. Congress was expected to complete work on the bill in January. It contains an $82.2 million allocation for 2004 under Section 747, a decrease of $10.2 million from the 2003 funding level. At one point, it had appeared the Section 747 funding would be cut entirely, an action the Academy helped prevent.
Under the guidance of Senate Majority Leader Bill Frist, R-Tenn., a patient safety bill was proceeding through the Senate in December and was expected to come up for a vote there this year. The House passed the companion bill last year. Endorsed by the Academy, the legislation incorporates voluntary, confidential reporting of medical errors as a step toward protecting patients' safety in health care.
To reach writer J. Michael Brodie, e-mail jbrodie@aafp.org.
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