Medicare payment update bill introduced on Capitol Hill

Friday, April 18, 2008 5:00:00 AM

Medicare payment update bill introduced
on Capitol Hill

AAFP Issues Speak Out Alert

AAFP encourages members to support a Senate bill that would block steep reductions in Medicare physician payment rates for the latter half of this year and all of 2009, giving Congress enough time to devise an alternative to the sustainable growth rate, or SGR, formula.

U.S. Sen. Debbie Stabenow, D-Mich., a member of the Senate Finance Committee, recently introduced S.B. 2785, or the “Save Medicare Act of 2008,” which would provide a 0.5-percent increase in the Medicare physician payment rate for the final six months of 2008 and a 1.8-percent increase for 2009. Under the current deadline, physicians face a 10.6-percent reduction starting July 1 and an additional 5-percent cut in 2009. The bill would also continue rural extender provisions set to expire such as the Work Geographic Practice Cost Indices and the Physician Scarcity Area bonuses.

Because Stabenow’s bill does not specify budgetary offsets needed to pay for the Medicare update, she acknowledged that passage of her bill in its complete form represents a “challenge.”

“The key thing is what will the president sign,” Stabenow said in an AAFP News Now article. The Bush administration and congressional Republicans oppose cuts to Medicare Advantage, Medicare’s managed care plan, to pay for Medicare payment updates, making it more difficult to find the budget offsets needed to pay for the elimination of the SGR.

Though this bill does not permanently fix the Medicare physician payment formula, it will provide physicians a degree of stability for the next 18 months, AAFP President Jim King, M.D., of Selmer, Tenn., told News Now. “This (bill) will give us some time to work with CMS and Congress to try and replace this broken SGR payment formula and put together a payment formula that makes sense. We think anything less than 18 months is not enough time to do that.”

In addition to Stabenow’s bill, other legislators are building support for their own bills to address the Medicare physician payment formula. Reps. Tom Price, R-Ga., and David Scott, D-Ga., filed House Resolution 5445 in February to delay cuts to Medicare physician payment rates until Dec. 31, 2009, to give Congress time to find a long-term solution. Sens. Max Baucus, D-Mont., chair of the Senate Finance Committee, and Charles Grassley, R-Iowa, the senior Republican member of the committee, are expected to introduce legislation before the cut goes into effect.

At a March 30 Texas Medical Association news conference, Sen. John Cornyn, R-Texas, spoke about his new legislation, Ensuring the Future Physician Workforce, that would fix the formula by eliminating the SGR. Also at the conference, TMA released the results from their 2008 Medicare Survey, giving a bleak diagnosis: inadequate and uncertain Medicare payments to physicians has forced doctors to limit the number of Medicare patients they can afford to see. Among the findings, the TMA survey found that the percentage of physicians who accept all new Medicare patients dropped to an all-time low in 2008, to 58.1 percent.

Nearly one-third of the 749 physician respondents decided to accept fewer new Medicare patients in the past three years while only 4 percent accept more new Medicare patients in the same period. More than 45 percent of family physicians and internists say they have cut back on accepting new Medicare patients in the past three years.

Additionally, 26 percent of respondents have already cut back on the charity care they deliver and 25 percent have delayed the implementation of health information technology.

AAFP encourages physicians to continue participating in the “Medicare: Stop the Cut Campaign,” which has already generated more than 800 messages to federal lawmakers since its launch on Feb. 9.