Speaking at the AMA Annual Meeting this weekend, Richard Deem, AMA senior vice president of advocacy, said the Senate’s continued inability to follow up on a House vote for a 19-month fee-fix will make “an utter mess” of physician claims in the short run.
CMS has not been processing physician Medicare claims since June 1, when Congress’ last fee-fix expired, but the delay can only continue through Monday under federal law. On Tuesday, CMS will begin applying the 21.3 percent reduction to all claims received as of June 1.
The new 19-month fee-fix, which is expected to pass eventually, would be retroactive to June 1. But claims submitted up until the time of passage would be subject to the cut. After passage, CMS would have to make a second payment covering the amount of the cut.
GOP calls for cuts to offset fee-fix
Senate Republicans are blocking the new $23 billion fee-fix because Democrats have not offset it with cuts in other federal spending. GOP leaders say they also support a fee-fix but believe Americans are dead-set against any growth in the deficit to pay for it.
“Even in the face of public outrage, Democrats are showing either that they just don’t get it on this issue of the debt, or that they just don’t care,” Sen. Mitch McConnell (R-Ky.), the minority leader, told the Associated Press.
President Obama fired back in a radio address on Saturday. The president urged passage of the 19-month fix and also endorsed permanent removal of the sustainable growth rate formula that causes the fee-cut.
“I am committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors,” Mr. Obama stated in his address. “A system where doctors are left to wonder if they’ll get fairly reimbursed makes absolutely no sense.”
Why a permanent fee-fix has been difficult to pass
The AMA supports a permanent fee-fix rather than temporary fixes, said outgoing AMA President J. James Rohack, MD, who is stepping down from his one-year term on Tuesday, the day CMS starts applying the cuts. Speaking at the same session as Mr. Deem, Dr. Rohack said the AMA has been disappointed time and again by federal lawmakers, who initially promised a permanent fix in the health reform legislation, then reneged. Many lawmakers have said, “I’m with you,” he said, but “the vote comes along and they vote no.”
Dr. Rohack said lawmakers’ dread of spending more money on the fee-fix is misplaced. Each delay in permanently fixing physician fees, he said, only adds to the cost. Five years ago, repealing the SGR would have cost $49 billion, he said, but today it would cost $250 billion and in five years it would cost half a trillion dollars, due to the increasing volume of healthcare services.
Mr. Deem added that arguments the fee-fix actually adds to the deficit are specious. Since Congress has never intended to implement the cuts, he argued, the permanent fee fix should not really be counted as added spending. “There is a phony baseline for the Medicare program that pretends these cuts are going to go into effect,” he said.
Even so, the veteran AMA lobbyist hinted a permanent fee-fix may be politically unfeasible any time soon. Mr. Deem said Congressional anxiety about deficits is “not going to get any better before the elections.” Lawmakers up for reelection are afraid of being punished at the polls in November. All the heightened concerns about deficits, he predicted, could take four or five years to recede.
How to light a fire under Congress
Mr. Obama, in his radio address, warned of the consequences of doing nothing to stop the 21.3 percent pay cut. Congressional inaction “would undoubtedly force some doctors to stop seeing Medicare patients altogether,” he said.
The AMA, pointing to physician opinion polls, is also predicting many practitioners would leave Medicare due to the cuts, but Dr. Rohack reported some lawmakers scoff at such warnings.
An AMA member asked Dr. Rohack what would be “the tipping point” when Congress would finally be convinced action must be taken. Dr. Rohack suggested simply refusing to see new Medicare patients might not be a tipping point, because it would not be reflected in CMS statistics. The data would show these physicians are still in Medicare. Congress would say, “Look, 95 percent of physicians are still participating in Medicare,” he said.
Physicians who opt out of Medicare completely, agreeing not to take any more Medicare funding for two years, would show up in the data, but Dr. Rohack suggested opting out might be a difficult step to take. He said the AMA wants to make opting out easier by trying to “reverse” the two-year requirement.
Dr. Rohack said lawmakers need to experience “a Dan Rostenkowski moment” to take the Medicare payment problem seriously. In 1988, when former Rep. Dan Rostenkowski (D-Ill.) was chairman of the powerful House Ways & Means Committee, Congress passed the Medicare Catastrophic Coverage Act, significantly increasing Medicare beneficiaries’ monthly premiums. Incensed over the added cost, a group of Medicare beneficiaries in his Chicago district surrounded Mr. Rostenkowski’s Lincoln Town Car and pounded on the hood, shouting “liar” and “coward” at him. In the wake of nationwide outrage, Congress repealed the bill.
The lesson, Dr. Rohack said, is to “get patients engaged.” In late May, the AMA started a multi-million-dollar advertising campaign in hopes of to stirring up beneficiaries’ dismay over Senate’s inability to pass a fee-fix. But the campaign has so far failed to spark action.
