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Wednesday Dec 21, 2011

Congress Fails Medicare Patients and Their Physicians

In a disgraceful display of partisan politics, Congress has put the health care of the more than 47 million Americans covered by Medicare and the practices of the physicians who care for those patients in jeopardy. Barring last-minute heroics -- which seem increasingly unlikely from the least-popular Congress(www.gallup.com) in the history of the Gallup poll -- physicians face a 27.4 percent Medicare payment reduction that is scheduled to take effect on Jan. 1.

Congress is receiving a failing grade from the AAFP regarding its actions on the Medicare payment situation. Although the majority of Republicans and Democrats in the House and Senate agree on the need to extend a payroll tax cut that affects 160 million Americans, extend benefits for millions of long-term unemployed, and -- most importantly to this audience -- maintain the current level of Medicare payments to physicians, they cannot agree on a solution.

Given an opportunity to address all three of these issues in the waning days of 2011, legislators accomplished exactly what you might expect from a group with an approval rating approaching single digits -- nothing.

So how did we get in this position?

On Dec. 20, the U.S. House of Representatives rejected a bill -- which had passed through the Senate with overwhelming bipartisan support -- that would have delayed an impending Medicare payment cut and extended the tax break and unemployment benefits for two months. The Senate bill was unacceptable to House Republicans because it offered only a short-term solution to problems that would have to be addressed again early in 2012.

A week earlier, the House had approved a bill that would have provided a 1 percent increase in Medicare physician payments for each of the next two years. However, the House bill was unacceptable to Senate Democrats because it also would have repealed or scaled back programs in the Patient Protection and Affordable Care Act.

Legislators from both sides of the aisle are behaving like children in a playground squabble, pointing fingers and calling names while their constituents suffer the consequences of their ineffectiveness.

The Senate already had adjourned for the holiday break when the House rejected the Senate's short-term solution and is not expected to return until Jan. 23, making it unlikely that the Medicare payment cut will be averted.

Although the Senate's two-month fix is not at all what the Academy wanted for the holidays -- or what it had been demanding -- it would have been better than the giant lump of coal the House has left us with. Whatever action Congress takes likely will be retroactive, creating billing nightmares for physicians and CMS, which has issued guidance(www.cms.gov)(www.cms.gov) instructing Medicare carriers to hold payments until at least Jan. 17 to give Congress additional time to reach an agreement.

Of course, Congress has had nearly a decade to solve this problem, passing short-term fixes to the sustainable growth rate, or SGR, formula every year from 2003 through last year. This year, lawmakers couldn't even manage to put another Band-Aid on the problem.

For those of you who are asking about your options regarding participation in the Medicare program, the AAFP has resources available online.

Many of you have been actively involved in our grassroots efforts on this issue. In fact, 2,443 of you sent 6,208 letters to your members of Congress during the past two months regarding the SGR and funding for Title VII programs and graduate medical education. I want to thank you. It will be imperative that legislators hear from us when they return to work in January. Congress needs to know how the Medicare payment cut will affect your practice and your patients' access to care. Nearly one-fourth of patients seen by family physicians are Medicare beneficiaries. For some of you, the percentage is much higher.

What's your story? Be ready to tell your legislators.

I am not asking you to contact your elected officials immediately (they're not there to answer your call or read your e-mail), but the Academy will be calling on members for an all-out effort to make our message heard early next month. I will provide you with details when it's time to act.

I want to emphasize that although a short-term solution will be needed to stabilize Medicare payments, the AAFP remains committed to its long-standing demand for a permanent fix. We are calling for a repeal of the SGR, a period of at least three to five years of payment stability, and at least a 3 percent positive payment differential for primary care compared to other specialties.

Our resolve hasn't wavered, and with your help, we will persevere to achieve this goal.


Posted at 02:55PM Dec 21, 2011 by Glen Stream, M.D., M.B.I.

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