2010 Annual Meeting

AMA Delegates Back New Medicare Payment Option

June 18, 2010 04:40 pm Barbara Bein

In response to concerns about patients' access to care, the AMA will draft legislation that calls for an additional payment option in Medicare fee-for-service that allows patients and physicians to contract for fees different from those included in the Medicare physician payment schedule. The legislative draft will be available by Sept. 30.

That is the gist of a substitute resolution adopted by delegates who attended the 2010 annual meeting of the AMA House of Delegates, June 12-16 in Chicago.

The substitute resolution offered by the AMA's reference committee on legislation combined several measures that, among other things,

  • criticized Medicare's continuing use of the sustainable growth rate, or SGR, formula to set physician payment rates;
  • pointed out that implementation of the annual negative payment updates mandated by the SGR formula repeatedly has been postponed by the U.S. Congress "specifically to maintain access to physician services for America's seniors and others through Medicare Part B";
  • decried the fact that Congress has failed to provide a permanent replacement for the SGR formula;
  • denounced the fact that Medicare restrictions on balance billing "reduce compensation to primary care physicians and discourage young physicians from entering the primary care specialties"; and
  • deplored Medicare's policy of total nonpayment of claims by Medicare enrollees who receive care under private contract with a physician.

AAFP President Lori Heim, M.D., of Vass, N.C., testified about one of the original measures during a June 13 hearing of the legislation reference committee.

In a subsequent interview with AAFP News Now, she said AAFP delegates to the AMA had some concerns about the language of the original resolution, which called for the AMA to write specific legislation that would be offered in the next session of Congress as a replacement for the SGR formula. The problem, Heim said, is that the measure offered no alternative payment structure, such as the Medicare economic index.

Moreover, she added, the measure was not explicit in ensuring that Medicare enrollees would continue to receive program benefits should they choose to independently negotiate the financial terms of services they received from a physician of their choice, regardless of that physician's Medicare status.

"The ability of patients to be able to negotiate with a physician who has 'opted out' of the Medicare program -- but not give up their benefits -- is a critical component. The final resolution acknowledged the needs of the patients and the physicians," said Heim.

"This is a very important issue for our members: the ability to negotiate with the patient directly," she added. "This is especially important in light of the failure to resolve the SGR. More and more physicians are looking at whether they can financially afford to remain a Medicare provider because of the instability of the system."

The final measure delegates adopted calls on the AMA to "immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule and in a manner that does not forfeit benefits otherwise available to the patient.

"This legislative language shall be available to our AMA members no later than Sept. 30, 2010."

In other action, delegates

  • adopted as new policy a resolution cosponsored by the AAFP that recognizes the need for all physicians who care for older adults -- regardless of specialty -- to be competent in geriatric care. The resolution encourages all appropriate specialty societies to identify and implement means to ensure "adequate education" in geriatrics at the medical school, graduate and CME levels;
  • adopted recommendations from a report by the AMA Council on Medical Education that ask the AMA to continue to advocate for funding from all payers to increase the number of graduate medical education positions in specialties leading to first certification; and
  • referred for further study a resolution that asks the AMA to encourage state medical licensing boards to accept certification by the Educational Commission for Foreign Medical Graduates as primary source verification of medical education credentials.

please wait Processing