AAFP Denounces 113th Congress' Failure to Tackle Medicare, Medicaid Payment

December 17, 2014 09:12 pm News Staff

"Woulda, coulda, shoulda."

Unfortunately, when it comes to the 113th Congress' inability to follow through on payment reform legislation that would have ensured seniors' continued access to primary care services, that familiar idiom applies.

[Male doctor sitting at desk with senior female patient]

In a Dec. 11 statement that chides lawmakers for purporting to seek reductions in unnecessary spending while still ensuring patients have ready access to health care -- but not acting to make it happen -- AAFP President Robert Wergin, M.D., of Milford, Neb., calls such claims "disingenuous."

"Despite their rhetorical goal to trim federal spending, the 113th Congress failed to repeal the sustainable growth rate (SGR) formula that determines Medicare payment for care provided to elderly and disabled Americans," Wergin says in the statement.

"Instead, last spring, legislators perpetuated the cycle of increasingly expensive temporary patches when they put aside substantive legislative proposals to repeal the SGR and instead resorted to a 17th short-term extension in order to prevent a double digit cut to physician Medicare payment," he notes.

That double-digit cut -- to the tune of about 21 percent -- kicks in on April 1 unless the 114th Congress intervenes to prevent it.

What's particularly regrettable, according to Wergin, is that a workable permanent solution was clearly in sight. "The House and Senate had before them a bipartisan bill to repeal the SGR for $118.9 billion -- far less than the $170 billion spent so far continuously passing temporary patches," he says. "But lawmakers could not agree on how to pay for a permanent solution."

The upshot? Legislators will now have to come up with $21 billion to enact yet another stop-gap measure by that April 1 deadline. Failing to do so could seriously hinder the ability of millions of Medicare beneficiaries to access care because it would leave the physicians who provide that care in uncertain financial waters.

Wergin's statement also addresses the second fiscal shoe that's set to drop for primary care physicians -- this one, by year's end.

"Despite the inevitable pay cut of up to 40 percent for primary care provided to low-income working families, Congress did not preserve a program that paid Medicare rates for primary care services provided by primary care physicians to Medicaid beneficiaries," Wergin says. "As a result, family physicians will see payment slashed for the care they provide to working families receiving Medicaid benefits."

This Medicaid payment cut stands to drive up costs across the entire health system, the statement notes, because if these patients have less access to care provided in a physician's office, it could push them to seek far more costly care in the ER.

Given that one in four patients in the typical family physician's office is a Medicare beneficiary, and one in five of their patients relies on Medicaid for health care services, the combined cuts could spell disaster for family medicine practices' financial stability, says Wergin in the statement.

"No medical practice can sustain such steep drops in payment and keep their doors open to serve patients. This destabilizing environment cannot continue. The cost to Americans’ well-being and to the nation's coffers is too high."

Wergin concludes by pledging that the AAFP will continue to work with Congress "to ensure early action on legislation that repeals the flawed SGR, re-establishes Medicaid payment to Medicare levels for primary care, and restores health care security to Medicare and Medicaid beneficiaries."