AAFP Ratchets Up Pressure for Medicare Payment Reform

Want to avoid a Medicare pay cut in 2007? Use the AAFP Speak Out to contact your federal legislators now.

Only a groundswell of support for legislation to avoid the scheduled cut will move Congress to act before adjournment for midterm elections, say AAFP officers who met Sept. 14 with leaders of the U.S. Senate and House.

In fact, those elections are the most likely culprit in stalling a congressional remedy to a 5.1 percent Medicare pay cut scheduled to go into effect Jan. 1, 2007, according to AAFP President Larry Fields, M.D., of Ashland, Ky., and President-Elect Rick Kellerman, M.D., of Wichita, Kan. Federal lawmakers are jockeying for the upper hand in campaign issues, and neither side of the aisle wants the other to take credit for resolving the Medicare payment issue, they said.

"The visits went well in that everyone said the right things; everyone said we need to do something," said Fields of his meetings, which included calls on the offices of Senate Majority Leader Bill Frist, M.D., R-Tenn., and House Majority Leader John Boehner, R-Ohio. "But they varied on what to do and they varied on when to do it, which in Washington means nothing will happen."

Kellerman agreed. In what he dubbed "the most frustrating Capitol Hill visit I've ever had in 15 years of making Hill visits," Kellerman heard senators and representatives from both parties agree the Medicare physician payment program requires change.

"Everyone we talked to said, 'Yes, this is a problem. Yes we agree with you. And no, it's not going to happen'" before elections or, possibly, the end of the year, said Kellerman.

Fields; Kellerman; and Tom Weida, M.D., of Hershey, Pa., speaker of the AAFP Congress of Delegates, joined members of the American College of Physicians and the American Osteopathic Association in a full-court press to pass Medicare physician payment legislation before Congress breaks for November elections. The three organizations were part of an overall AMA fly-in on Sept. 13 that drew hundreds of physicians to Capitol Hill to urge congressional action.

Without congressional intervention, Medicare will cut physician payment by 5.1 percent in 2007; unchecked by congressional action, the cuts will continue for the next eight years for a 40 percent reduction overall. The reductions are required by the current payment system, which uses the sustainable growth rate, or SGR, to calculate physician payment. AAFP and its medical colleagues have called for a payment formula that discards the SGR and uses the Medicare Economic Index, which more accurately reflects physicians' cost of business and avoids the annual reductions in Medicare physician payments.

Whether the U.S. Senate and House will act remained unclear at the end of Fields', Kellerman's and Weida's visits, said Doreen Bell, AAFP government relations representative.

While Sen. Frist's office was telling Fields that a Medicare payment solution could occur before the elections, his spokesman William Hoagland was announcing no action until the congressional lame-duck session, said Bell.

Even with the confusion, there has been activity related to physician payment, showing that legislators understand the issue and are interested in it.

House Ways and Means Committee Chairman Bill Thomas, R-Calif., announced plans to tack a Medicare fix onto legislation that would freeze Medicare payments for 2007 at 2006 levels. With the legislation, payment would increase by 2.8 percent in the middle of next year if physicians participate in CMS quality reporting programs, and payment would be cut by 5 percent to doctors who don’t participate. Another proposal being developed would freeze physician payment for three years, institute a quality reporting pilot project in 2007, provide updates of 2.5 percent for quality reporting in 2008-2009 and allow physicians to charge higher-income patients more for their care. That legislation, expected to be introduced by House Energy and Commerce Chairman Joe Barton, R-Texas, could cost as much as $30 billion over five years.

The AAFP has rejected both proposals in principle because they do not guarantee a positive update in Medicare for 2007, said Fields.

A Sept. 11 letter signed by more than 260 House members asked House Speaker J. Dennis Hastert, R-Ill., and Minority Leader Nancy Pelosi, D-Calif., to take action that would avoid a physician payment cut. Eighty senators took similar action in a July letter (PDF file: 6 pages / 173 KB. More about PDFs. to Republican and Democratic leaders to stop the scheduled Medicare cuts.

“It's beyond me how 80 percent of the U.S. Senate and more than half of the House can be for something and nothing gets done,” said Fields.

Kellerman agreed. “This is an indication of the extreme partisanship and finger-pointing in Congress,” he said.

Grassroots efforts would help, Kellerman added. “This will take massive effort by members to call individual senators and representatives and tell them to get the leadership in both houses and on both sides moving on this issue,” he said. “Our members have to get on the horn. (Congress must know) this is not the way to take care of patients. That was our bottom line."