AAFP Moves to Kill Senate Amendment to Health Care Bill

The AAFP has moved quickly to oppose a Senate amendment that would postpone for one year a new CMS rule eliminating Medicare payments for consultation codes and a resulting increase in payments for primary care physicians.

In a prepared statement, the AAFP voiced its strong opposition to a Senate amendment introduced by Sen. Arlen Specter, D-Pa., as part of the Senate health care reform bill, H.R. 3590 (at the THOMAS Web site, type "H.R. 3590" in the search box after selecting "Bill Number"). The amendment would postpone a CMS rule to eliminate Medicare payment for consultation codes and redistribute the savings to office visits and selected other evaluation and management services.

The elimination of the Medicare consulting fees would result in a 6 percent increase in the work relative value units for office visits in 2010 and would serve as part of a projected overall increase of 4 percent in Medicare-allowed charges for family physicians contained in the 2010 Medicare rule.

According to the AAFP statement, the Specter amendment also would prolong the "wasteful spending" called out in the 2006 Office of the Inspector General Report, "Consultations in Medicare: Coding and Reimbursement." That report found 19 percent of Medicare payments for consultation codes in 2001, or $191 million, did not meet Medicare's definition of a consultation. In addition, 47 percent of payments, or $614 million, were billed as the wrong type or level of consultation. Another 9 percent of payments, or $260 million, were not substantiated by documentation.

Overall, 75 percent of services billed as consultations and allowed by Medicare in 2001 did not meet all applicable program requirements, resulting in $1.1 billion in improper payments, according to the OIG, said the AAFP.

"Decades of physician payment polices have worn down the primary care foundation of our nation's health system," said the AAFP statement. "Today, Americans struggle with a serious and growing primary care physician shortage in a fragmented, confusing and costly system."

The AAFP also sent a Speak Out alert to Academy members in Pennsylvania, urging them to call Specter to voice their opposition to the amendment. In the meantime, the Academy has provided the Pennsylvania AFP with talking points on the amendment.

In a letter to Specter, the Pennsylvania AFP has urged the senator to withdraw the amendment and to refrain from any subsequent amendments that would "undermine primary care medicine in this commonwealth and the United States."

"It is our collective opinion your amendment sends a message that wasteful spending is not important and that primary care is secondary to preserving excessive payments to (sub)specialists," the Pennsylvania AFP said.