Proposed Legislation Would Clear Path to Permanent Medicare Physician Payment Fix

A movement to permanently fix Medicare's physician fee schedule began working its way through the U.S. Senate Wednesday when Sen. Debbie Stabenow, D-Mich., introduced the Medicare Physician Fairness Act of 2009, or S. 1776. (at the THOMAS Web site, type "S. 1776" in the search box after selecting "Bill Number") Now, the AAFP is using its Speak Out alert system to ask members to contact their legislators to support the bill.

"This legislation is going to move very quickly, so we need to act now to ensure that it passes," said AAFP President Lori Heim, M.D.

The bill would reset the sustainable growth rate, or SGR, formula, which Medicare currently uses to calculate the physician fee schedule, to zero and eliminate the $245 billion debt that has accumulated during the past six years as a result of Congressional "fixes" to ensure physician payments were not reduced.

"S. 1776 would mean that Congress can finally recognize that the annual overriding of the reductions that the badly designed (SGR) formula generate is simply postponing the needed replacement of the payment formula," says the Speak Out letter from the AAFP. "It is critically important for Congress to face this responsibility and pass S. 1776 this week."

Before S. 1776 can reach the Senate floor, it must garner the support of at least 60 senators on three procedural votes: a motion to end debate; a motion to waive a budget point of order because the measure is not offset in the budget; and a motion to proceed to the bill. Each of these will require a super majority of 60 votes, with the first vote expected on Monday.

"Senators need to hear from physicians today on the importance of voting in favor of each of these procedural votes," said Heim. "We need 60 'aye' votes on each of these steps so the full Senate can take up this bill. Without this legislation, we won't have a permanent payment fix, and we're facing a 21 percent cut in Medicare payment at the end of the year."

Budgetary rules require Congress to offset any increased spending for health care reform. If the $245 billion in accumulated SGR-related debt is not reset to zero, money to improve payments to primary care physicians must be taken from other services or would require additional revenue measures. Resetting the SGR debt, however, will allow Congress to establish a new payment system based on quality of care rather than the quantity of procedures or services, according Heim.

"Health care reform really does require that we address the flawed current formula for Medicare payments," said Heim. "This would give us the basis for that fix."