Toolkit Designed to Help Drive Efforts to Fix Broken Payment System

August 23, 2010 03:45 pm James Arvantes

As part of an ongoing effort to replace the current Medicare physician payment system with a more equitable system that better rewards the provision of primary care services, the AAFP has developed a toolkit to help family physicians and their patients generate support for fixing the system.

"This toolkit is really a means of being able to educate the public and patients about the impact of the SGR (sustainable growth rate) on patient access to health care," AAFP President Lori Heim, M.D., of Vass, N.C., told AAFP News Now. Physicians "are not going to be able to fix the SGR alone," she added.

"Patients and the public have to be informed and they have to be engaged, so they can demand that Congress fix this."

The toolkit, which is available for physicians to download and distribute, contains the following documents:

  • a one-page fact sheet that briefly describes the current Medicare payment system and what steps Congress can take to make the system more equitable. The document also cites talking points for use with Congress, the media and patients, and it contains tips on how to make the voice of family physicians heard on Capitol Hill;
  • a sample letter that physicians can send to their patients explaining problems with the current payment system and what patients can do to help fix the broken system; and
  • a sample letter that patients can send to their respective representatives in Congress that describes the effect of the SGR on physician practices and patient care and what steps Congress can take to make the payment system work better for physicians and their patients.

The SGR formula has called repeatedly for steep reductions in the Medicare payment rate during the past several years, forcing Congress to continually intervene to block the reductions. The ongoing threat of payment cuts has created a great deal of anxiety among physicians and their patients.

In June, for example, Congress passed a temporary payment patch that effectively blocked a steep Medicare payment reduction until Nov. 30. Without congressional action, however, physicians face a more than 23 percent Medicare payment reduction on Dec. 1, followed by an additional reduction in 2011.

Each of the documents that comprise the toolkit calls for a permanent fix to the SGR and a positive payment differential for primary care physicians to better reward provision of primary care services. But each document conveys that message differently based on the target audience.

The sample congressional letter from patients, for example, urges members of Congress to "permanently fix the SGR formula" and to provide a better payment rate for primary care physicians. This means "paying an enhanced rate to those doctors who coordinate and care for the whole person at every age, not just a certain body part or particular age group," the letter says.

The sample letter also points out that "many of America's family physicians are small businesses."

"They are very committed to their patients, like me, but need to make enough money to keep their doors open, like any business," the letter states.

Congress, meanwhile, is expected to address the Medicare physician payment rate after the Nov. 2 midterm elections. It is difficult for lawmakers to pass legislation permanently replacing the SGR because of the cost involved in eliminating the current payment formula.

"Especially in the lame-duck session, we are going to have a difficult time convincing Congress to fix the SGR permanently," said Heim. "Congress is not going to want to add to the deficit. The only thing that is going to change the mind of (members of) Congress is if legislators hear from enough physicians and patients -- particularly patients."