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Eleventh-Hour Vote Avoids Medicare Cut
AAFP President Calls Congress' Action 'Real Win' for AAFP, FPs
The end result: a slight increase in Medicare payment for the two most commonly billed primary care codes.
"Overall, this is a real win" for the Academy and for family physicians, said AAFP President Rick Kellerman, M.D., of Wichita, Kan. "To the thousands of family physicians who called their legislators, talked to legislative aides, sent faxes or e-mails -- thank you. For those who didn't, thank someone who did. You owe them … literally!"
Because lawmakers did not change the recently announced adjustments to the relative value units for E/M codes, payment for CPT code 99213 will increase by $6.83, or 13 percent, and CPT code 99214 payments will rise by $7.58, or 9 percent. When accounting for the increases in E/M services and the decreases in non-E/M services provided by FPs, the overall impact on Medicare-allowed charges to family physicians would be a 5 percent increase in 2007.
The E/M code changes take on added significance, said Kellerman, because "several major national insurance companies have told us they will adopt the new Medicare E/M relative value units."
The legislation passed by Congress contains several other provisions AAFP advocated throughout the 109th Congress. For example, physician reporting provisions laid out in the bill generally parallel Academy recommendations that
- reporting requirements begin with a small number of measures;
- quality measures be endorsed by a consensus organization, such as the National Quality Forum or the Ambulatory Care Quality Alliance, which was co-founded by the AAFP; and
- the set of reporting measures include structural measures, such as the use of electronic health records.
Despite the 11th-hour victory, the campaign for Medicare reform of the sustainable growth rate, or SGR, still lies ahead, said Kellerman. It is the SGR, which Medicare bases its physician payments on, that has required annual physician pay cuts since 2002.
"We still have a way to go because our ultimate goal is to fix the SGR," said Kellerman.
Next year, the Academy will focus efforts on advocating adoption of legislation that implements the AAFP's policy on restructuring the Medicare payment system. That policy calls for replacing the SGR with a stable, predictable annual update based on the Medicare economic index, which reflects inflation in the health care sector. Such a system should be linked to quality and should reward physicians who provide high-quality, efficient patient care, according to the Academy.
Online Tool Calculates Changes in 2007 Medicare Income
(12/13/06)
Physician Payment Reform Leads AAFP Priorities for 110th Congress
(11/16/2006)
E/M Increases Offer Bright Spot in CMS Final Rule
(11/8/2006)
Alternative to SGR?
Lawmakers Look to Fix Physician Payment Formula
(8/8/2006)
Physician Fee Schedule Changes
CMS Targets Many E/M Services for Increases
(6/28/2006)
Fix SGR Problem, Says AAFP in Comments on Medicare Fee Schedule
(1/11/2006)
More From AAFP
"Medicare Program: Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2007 and Other Changes to Payment Under Part B,"
(PDF file: 8 pages / 55 KB. More about PDFs.)
"Medicare Program: Five Year Review of Work Relative Value Units Under the Physician Fee Schedule and Proposed Changes to the Practice Expense Methodology,"
(PDF file: 10 pages / 63 KB. More about PDFs.)
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