AAFP Executive Committee Says 'No' to Further Medicare Payment Patches Unless They Meet Academy Criteria

May 28, 2010 12:55 am News Staff

The AAFP's executive committee has decided that if Congress cannot provide a permanent fix for the Medicare physician payment formula, then the AAFP will not support any legislation that provides a temporary payment patch unless the legislation meets the Academy's new criteria. Those criteria are that any temporary measure must include a primary care payment differential and must extend at least through Dec. 31, 2012.

For the second time in a two-month period, Congress has failed to stop a large Medicare payment reduction based on the sustainable growth rate, or SGR, formula from going into effect; thus, physicians are facing a 21.3 percent reduction in the Medicare payment rate as of June 1.

Although the AAFP has supported payment patches required by the SGR in the past, Congress' inability to replace the payment formula or to even provide a long-term reprieve has prompted the organization to revise its position.

Physicians are compensating their staff members and paying their bills using 2010 dollars, but they are still being paid at 2001 rates under Medicare because of the SGR, said AAFP President Lori Heim, M.D., of Vass, N.C.

"Now, because Congress has failed to avert the 21 percent cut, family physicians are earning less today than they earned a decade ago," Heim said in a prepared statement.

"Family physicians are outraged that Congress has jeopardized the health care security of millions of elderly and disabled Americans who depend on Medicare and TRICARE," said Heim.

She called on Congress to "retroactively rescind this pay cut and replace the deeply flawed SGR formula with one that reflects actual practice costs that physicians experience."

"The political gamesmanship must end," Heim declared. "A comprehensive and stable Medicare payment system must be put in place. The time to begin that process is now."

The House was considering a proposal earlier this month that would have provided a Medicare payment update for the next three-and-a-half years. That proposal also included a differential increase for primary care services in 2012-2013. But the House leadership was unable to find enough offsets in the budget to pay for the proposal.

Congress was faced with a similar situation in March when it failed to block a payment cut that took effect April 1 under the SGR. In that instance, CMS held payment of claims from April 1-15 to give Congress more time to pass a payment patch, thus negating the actual impact of the cut on physicians.

In the current situation, CMS has again stepped in and said it will delay the processing of claims to prevent the June 1 cut from actually affecting physician payment rates temporarily.