Rounds NEWS FROM AMERICA’S BEST MEDICAL SOCIETY
CMS: Stop us before we do something stupid
Medicare says it will lower payments to physicians by 29.5 percent at the end of the year, a cut so drastic that even the man in charge says it must be stopped. “This payment cut would have serious consequences, and we cannot and will not
allow it to happen,” said Centers for Medicare & Medicaid Services Administrator Donald Berwick, MD. “We need a permanent SGR [Sustainable Growth Rate] fix to solve this problem once and for all. That’s why the president’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and imple- ment a permanent and sustainable fix.” Medicare payments are based on the SGR formula, established by the Balanced Budget Act of 1997. The fee reduction will take effect Jan. 1 unless Congress acts, either by replacing the SGR with a fair payment system, or, as it has done in for the last decade, passing last-minute legislation to stop the SGR-mandated cuts and institute small increases. In March, the Texas Medical Association joined the American Medical Association and several other state medical societies to urge Congress to “begin working in a bipartisan, bicameral manner” to eliminate the SGR “and lay the groundwork for adoption of broader physician payment and delivery reforms.” “Last year, Congress was required to act five times to pass short-term measures (for as short as one month) to stop Medicare physician payment cuts scheduled for 2010,” the groups said in a letter to Congress. “On three occasions Congress failed to act before cuts were implemented, causing disruptions in processing Medicare pay- ments. These payment uncertainties and delays created serious problems for many physician practices and jeopardized seniors’ access to care.” Ultimately, the letter said, “Congress and the Administration worked together in
a bipartisan manner” to stop the planned fee cuts and stabilize Medicare physician payments through 2011. “It is our hope that Congress can again work together this year to end the cycle of temporary patches once and for all and develop a long-term and meaningful solution to this issue.”
Earlier this month, AMA said it supports legislation to repeal the Independent
Payment Advisory Board (IPAB), created by the health system reform bill to reduce Medicare spending. AMA says the IPAB would make physicians subject to double jeopardy under both the IPAB and the SGR. The latest CMS fee proposal updates several physician incentive programs, includ- ing the Physician Quality Reporting System, the e-Prescribing Incentive Program, and the Electronic Health Records Incentive Program. It also includes proposed quality and cost measures to establish a new value-based modifier that would reward physi- cians for providing higher quality and more efficient care.
The Congressional Budget Office (CBO) published a report summarizing the impact and budgetary costs of vari- ous SGR fixes. According to its analysis, the 10-year budgetary cost of a corrected fee sched- ule update formula that allows small an- nual increases to partially offset increas- ing operating costs for physicians now exceeds $350 billion. The more Congress postpones the problem, the larger the price will get. Nonetheless, Congress may opt for another temporary patch. To read the full CBO analysis, log on to
www.cbo.gov/ftpdocs/122xx/ doc12240/SGR_Menu_2011.pdf.
Getting preexisting coverage easier
Physicians can help patients obtain im- mediate health insurance coverage for preexisting conditions, now that the federal government has relaxed eligibil- ity requirements. Previously, patients had to submit a letter from a private insurer denying coverage because of a preexisting condi- tion before obtaining coverage under the Pre-Existing Condition Insurance Plan (PCIP). Now, patients can submit a letter from a physician, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or had a medical condition, disability, or illness. The letter must include the patient’s name and medical condition, disability, or illness, and the name, license number, state of licensure, and signature of the physician, physician assistant, or nurse practitioner.
September 2011 TEXAS MEDICINE 7
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