AAFP: Congress Must Eliminate Dysfunctional SGR Formula that Imposes Drastic Pay Cut in 2015 Medicare Physician Fee Schedule

Tuesday, Nov. 4, 2014

Statement attributable to:
Robert Wergin, MD
American Academy of Family Physicians

“The American Academy of Family Physicians is extremely disappointed that, once again, current law requires CMS to slash Medicare physician payment by 21.2 percent on April 1. Without Congressional action to permanently repeal the sustainable growth rate formula that requires this devastating cut, Medicare patients will continue to struggle with insecure access to health care.

“Family physicians applaud the planned payment of a new chronic care management code, because it is a step toward recognizing the value of the often complicated clinical oversight that – although needed by many Medicare beneficiaries – requires significant clinical time outside the exam room. As a result of implementing payment for this code, elderly and disabled patients will have better access to the care they need to reduce and avoid complications of their conditions and expenses that come with treating such complications. The AAFP will monitor the documentation requirements related to these codes to ensure they are not overly burdensome for practicing physicians.

“The AAFP also commends CMS for its efforts to ensure the accuracy of billing codes, and to identify and adjust over-valued codes. We continue to urge CMS to review undervalued codes and ensure appropriate payment for primary care services and the complexity/intensity of those services. Moreover, the complexity and intensity of primary medical care justifies creating separate, outpatient, primary care evaluation and management codes, and we urge CMS to create such codes to recognize the medical expertise required to provide this comprehensive care.

“However, we are disappointed that CMS is deleting the exemption for AAFP-accredited CME in the Open Payments reporting requirements. The AAFP strongly supports transparency and understands the need for it to ensure that manufacturer influence on physicians is eliminated. However, removing exemptions for AAFP-accredited CME from reporting requirements could cause disruption and confusion, and could discourage well-qualified CME presenters from participating in future physician education activities.”


Editor's Note: To arrange an interview with Dr. Wergin, contact Janelle Davis, 800-274-2237, Ext. 5222, or jdavis@aafp.org.

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Founded in 1947, the American Academy of Family Physicians represents 136,700 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

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