Friday, December 30, 2011
Thursday, December 29, 2011
Friday, December 23, 2011
Thursday, December 22, 2011
An Important Message from the ACS
With just six working days until physicians face a 27.4 percent cut in their Medicare reimbursement rate, Congress left Washington without providing a solution. With no resolution in sight, Medicare reimbursement rates will be cut 27.4 percent on January 1, 2012. We know how frustrating and challenging this situation is for you, we are working as hard as we can on a daily basis to move Congress in the right direction. Earlier this week, the Centers for Medicare and Medicaid Services (CMS) issued a statement detailing how they will handle claims starting on January 1st. On Wednesday, the American College of Surgeons issued a statement detailing our frustration with Congress’ lack of attention to this critical issue for patients.
For those interested in the background as to how this all came about in the past few weeks, we have included the details at the end of this email.
The ACS remains committed to advocating for a full and comprehensive repeal of the sustainable growth rate formula used to determine Medicare physician payment and for an equitable, long-term solution to the problem. The ACS maintains that continued short-term fixes only exacerbate the problem and increase the long-term deficit. For more information on the College’s views on Medicare payment, CLICK HERE.
At this time, it is unclear when Congress will resolve its political differences. We will continue to stay in touch with you in the coming weeks.
Sincerely,
Patricia J. Numann, MD, FACS
President
J. David Richardson, MD, FACS
Chair, Board of Regents
Andrew L. Warshaw, MD, FACS
Chair, Health Policy and Advocacy Group
David B. Hoyt, MD, FACS
Executive Director
Background Information
Over the past two weeks, the deep partisan divide in Washington has been on display with both sides talking past each other and little effort to bridge the differences. The physician payment issue, along with the payroll tax cut and unemployment compensation, were used as political footballs between Democrats and Republicans as well as the House and Senate. First, the U.S. House of Representatives passed H.R. 3630, the Middle Class Tax Relief and Job Creation Act, which included a two-year short-term fix with a one percent increase in 2012 and another one percent increase in 2013. That two percent total increase would be nullified by the two percent cut that physicians are facing via sequestration beginning January 1, 2013, because the Joint Select Committee on Deficit Reduction—the congressional “Super Committee”—failed to craft a plan that would cut the nation’s debt by the required $1.2 trillion.
The American College of Surgeons (ACS) did not support or oppose the legislation as it simply exacerbated the problem on many levels. The House bill “kicked the can down the road,” creating a 37 percent cut in 2014 and increasing the cost to fully fix the problem to a staggering $370 billion. The more it costs to fully fix the problem, the less likely it is that Congress will ever be able to pass comprehensive repeal legislation. Congress could have fixed this problem six years ago for a total cost of $48 billion.
Senate Democrats and the White House immediately denounced the House bill as politically divisive because of the offsets used to pay for the legislation. Indeed, it was known before the House voted on the bill that it would not pass the Senate.
In response, Senate Democratic and Republican leadership spent most of last week in negotiations for a short-term legislative package including physician payment, the payroll tax cut and unemployment insurance. This past Saturday, the Senate passed a bill that would stop the 27.4 percent cut for 60 days. The negotiators attempted to reach a deal for one year, but the cost offsets again proved to be a major roadblock. Upon passage, the Senate immediately adjourned with no plans to return to Washington until January 24, 2012.
In the circular logic that only makes sense to Congress, the House was called back in to session; rejected the 60 day extension on Tuesday and passed a bill to appoint conferees that would work to bridge the gap between the House and Senate bills. The major problem – the Senate is no longer in Washington and will not appoint conferees.
For those interested in the background as to how this all came about in the past few weeks, we have included the details at the end of this email.
The ACS remains committed to advocating for a full and comprehensive repeal of the sustainable growth rate formula used to determine Medicare physician payment and for an equitable, long-term solution to the problem. The ACS maintains that continued short-term fixes only exacerbate the problem and increase the long-term deficit. For more information on the College’s views on Medicare payment, CLICK HERE.
At this time, it is unclear when Congress will resolve its political differences. We will continue to stay in touch with you in the coming weeks.
Sincerely,
Patricia J. Numann, MD, FACS
President
J. David Richardson, MD, FACS
Chair, Board of Regents
Andrew L. Warshaw, MD, FACS
Chair, Health Policy and Advocacy Group
David B. Hoyt, MD, FACS
Executive Director
Background Information
Over the past two weeks, the deep partisan divide in Washington has been on display with both sides talking past each other and little effort to bridge the differences. The physician payment issue, along with the payroll tax cut and unemployment compensation, were used as political footballs between Democrats and Republicans as well as the House and Senate. First, the U.S. House of Representatives passed H.R. 3630, the Middle Class Tax Relief and Job Creation Act, which included a two-year short-term fix with a one percent increase in 2012 and another one percent increase in 2013. That two percent total increase would be nullified by the two percent cut that physicians are facing via sequestration beginning January 1, 2013, because the Joint Select Committee on Deficit Reduction—the congressional “Super Committee”—failed to craft a plan that would cut the nation’s debt by the required $1.2 trillion.
The American College of Surgeons (ACS) did not support or oppose the legislation as it simply exacerbated the problem on many levels. The House bill “kicked the can down the road,” creating a 37 percent cut in 2014 and increasing the cost to fully fix the problem to a staggering $370 billion. The more it costs to fully fix the problem, the less likely it is that Congress will ever be able to pass comprehensive repeal legislation. Congress could have fixed this problem six years ago for a total cost of $48 billion.
Senate Democrats and the White House immediately denounced the House bill as politically divisive because of the offsets used to pay for the legislation. Indeed, it was known before the House voted on the bill that it would not pass the Senate.
In response, Senate Democratic and Republican leadership spent most of last week in negotiations for a short-term legislative package including physician payment, the payroll tax cut and unemployment insurance. This past Saturday, the Senate passed a bill that would stop the 27.4 percent cut for 60 days. The negotiators attempted to reach a deal for one year, but the cost offsets again proved to be a major roadblock. Upon passage, the Senate immediately adjourned with no plans to return to Washington until January 24, 2012.
In the circular logic that only makes sense to Congress, the House was called back in to session; rejected the 60 day extension on Tuesday and passed a bill to appoint conferees that would work to bridge the gap between the House and Senate bills. The major problem – the Senate is no longer in Washington and will not appoint conferees.
Wednesday, December 21, 2011
Message from AMA via MAG concerning SGR.
Today, the House of Representatives held a series of votes regarding H.R. 3630, legislation that would extend an expiring payroll tax reduction and unemployment insurance benefits, as well as stop a 27.4 percent Medicare physician payment cut that is scheduled to take effect on January 1. The net result was to leave the status of 2012 payment rates in limbo.
Votes on H.R. 3690. As originally passed by the House on December 13 by a vote of 234-193, the legislation would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But, due to disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.
On December 17, the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies, including current Medicare physician payment rates, for two months. The rationale for the short-term extension was to avoid disruptions on January 1 and provide time for further negotiations on financing longer-term extensions.
House action on December 20. Following the Senate’s action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for today. Most important of these, the House approved a resolution by a vote of 229-193 to disagree with the Senate and appoint members to a House-Senate conference committee, which would be charged with working out differences between the two versions of the bill.
Prior to the House votes today, the Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House are departing this evening for the holidays, after being informed that they could be called back to Washington
Outlook for January. On December 19, the Centers for Medicare and Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days, until January 17, to avoid processing payments at the lower rate. After that date claims will be processed on a first in, first paid basis at the reduced rates until the situation is resolved.
The House is currently scheduled to return to Washington
AMA views. The AMA issued strong statements following the House and Senate votes reaffirming its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal flawed and disruptive formula once and for all.
Throughout the year, the AMA has been pursuing a strategy for repealing the SGR that was developed in consultation with state medical societies and national medical specialty societies. We continued to oppose short-term remedies that serve to make future cuts deeper and the cost of permanent payment reform increasingly steep. And, throughout the year, bicameral and bipartisan support has been expressed in Congress for permanently addressing the Medicare physician payment crisis. Nonetheless, physicians and their patients once again find themselves confronting uncertainty and instability. It is long past time for Congress to act decisively and protect access to care for senior citizens and military families that rely on TRICARE—they and their physicians deserve better.
The AMA will provide additional updates on the status of the 2012 payment rates as events unfold. With the expectation that Congress will be in recess, we will defer any new grassroots messaging between now and the New Year. New grassroots messages will be available after January 1 or if Congress decides to return to Washington
Tuesday, December 20, 2011
Sunday, December 18, 2011
A message from ACS Dvision of Advocacy and Health Policy
ACS Leaders
Informal Sunday email from the ACS Washington Office …. Things are not looking good….. Bottom line, in the past 24 hours, the odds of the 27.4% cut going into effect on January 1st appear to be increasing. Below is a quick summary of where things stand.
First, earlier this past week, the House passed legislation (almost all Republicans voted in favor and almost all Democrats opposed) that would stop the 27.4 percent cut for two years. It would create a 37% cut and $370 billion debt in 2014. The opposition was about how the bill was paid for.
Yesterday (Saturday) morning, the Senate passed legislation that would stop the 27.4 percent cut for 2 months. The legislation also extends the payroll tax holiday and unemployment insurance for 2 months.
The problem in getting a longer fix is that Republicans and Democrats can't agree on how to pay for a bill that would have stopped the cut for longer.
The ACS continues to not support or oppose these short term deals -- they make the problem much worse on many levels. The ACS continues to urge Congress to fully fix the SGR.
In the past 24 hours, it has become clear that the House Republicans will not accept the Senate deal that was passed yesterday. It is unclear at this point as to whether the House will attempt to modify the Senate bill or push for a conference committee with the Senate. The problem is that the Senate has adjourned and is not scheduled back until Jan 24th. Senate Majority Leader Harry Reid’s spokesperson has said Senator Reid has no plans to bring the Senate back to Washington.
In my humble opinion, the blame seems to be equally divided between Republicans and Democrats.
I will stay in touch and at some point when things become clearer, there will be an email sent to all Fellows from Drs. Richardson, Numann, Warshaw and Hoyt.
Any questions, let me know
Christian
Christian Shalgian
Director
Division of Advocacy and Health Policy
American College of Surgeons
20 F St, NW Suite 1000
Washington, DC 20001
Email: cshalgian@facs.org
Phone: 202-672-1504
Wednesday, December 14, 2011
Tuesday, December 13, 2011
Monday, December 12, 2011
A message from ACS Dvision of Advocacy and Health Policy
To: ACS Leaders…..
It is December 9th …. 27.4% cut is scheduled to go into effect in 22 days. Here is where we stand….
The House Republicans introduced a large bill today that includes a number of things. One section of the bill deals with Medicare physician payment. The bill would stop the cut for 2 years and provide a 1% positive update (which would likely disappear in 2013 because of the failure of the Super Committee – sequestration). The bill includes a number of provisions un-related to Medicare. There are a number of “pay fors” in the bill including some substantial cuts to hospitals (the hospital groups are very upset). While essentially freezing physician payments for two years, the bill would leave a 37% cut in physician payments in 2014 and would increase the debt on this program from $300 billion to close to $370 billion. We met with House Republican leadership staff this morning and they told us that the plan is to have the House vote on this bill early next week (possibly Tues?).
The concept of fully eliminating the current SGR debt ($300 billion) by using unspent war funds is still alive in the Senate. Senators Harry Reid (D-NV), John Kyl (R-AZ) , Max Baucus (D-MT) and Debbie Stabenow (D-MI) continue to lead this effort.
Congress is scheduled to leave for the year next Friday. We shall see if that happens……
As always, let me know if you have any questions.
Christian
Christian Shalgian
Director
Dvision of Advocacy and Health Policy
American College of Surgeons
20 F St, NW Suite 1000
Washington, DC 20001
Email: cshalgian@facs.org
Phone: 202-672-1504
Friday, December 9, 2011
Thursday, December 8, 2011
Wednesday, December 7, 2011
Important news related to Medicare physician payment - ACS Div Advocacy & Health Policy
To: ACS leaders…..
Yesterday, Senator Jon Kyl (R-AZ) came out in favor of using the overseas contingency operations money (war drawdown savings) to pay for a full fix to the SGR (eliminating the $300 billion debt). This is significant because Senator Kyl is the second ranking Republican in the Senate. Both Senate Majority Leader Harry Reid (D-NV) and House Minority Leader Nancy Pelosi (D-CA) have made recent statements supporting using the funds to pay for the SGR fix. The public opposition to using these funds to eliminate the SGR debt have mostly come from House Republican leadership. We have also not seen any public statements of support for this effort from the physician members of the House.
There is some expectation that the House Republicans will come out today with a piece of legislation that includes a number of things including a two year temporary fix to the Medicare physician payment crisis. A two year fix will obviously stop the 27.4 percent cut scheduled for January 1st but will lead to a 37% cut on January 1, 2014. The cost to truly fix this problem will also rise from approximately $300 billion to close to $400 billion at that point.
We continue to urge all Members of Congress to fully fix the Medicare physician payment crisis and not create a larger fiscal debt for the Medicare program.
I will stay in touch with you in the coming days as this critical issue is debated in Congress. If you have any questions, please let me know.
Christian Shalgian
Director
Division of Advocacy and Health Policy
American College of Surgeons
20 F St, NW Suite 1000
Washington, DC 20001
Email: cshalgian@facs.org
Phone: 202-672-1504
Monday, December 5, 2011
ACTION NEEDED TO STOP SGR CUT
ACTION NEEDED
Contact Congress TODAY to urge them to stop the 27.4 percent cut to Medicare physician payments scheduled to go into effect on January 1, 2012, and permanently fix this broken system, by logging into the ACS Legislative Action Center at http://www.capitolconnect.com/acspa/actionalerts.aspx.
Dear Dr. Harris:
We are writing because we need your active involvement today. The American College of Surgeons has been advocating that the Joint Select Committee on Deficit Reduction, known as the "Congressional Super Committee," permanently fix the broken Medicare payment system as part of its larger effort. The Super Committee failed to reach its goal of saving $1.2 trillion and will not be addressing the physician payment issue.
Congress is scheduled to be in Washington until mid-December. There is a 27.4 percent cut in Medicare physician payment scheduled for January 1. The grim financial environment in Washington makes the likelihood of a cut to Medicare physician payments greater this year than in recent years.
The American College of Surgeons continues to strongly advocate for Congress to stop these cuts and repeal the SGR. However, Congress also needs to hear from the surgeons whose ability to practice and care for patients in their states and districts is being threatened by the failure to enact permanent reform of Medicare’s broken payment system. As a result, it is critical that ALL FELLOWS contact Congress TODAY and tell them to stop the cut.
Please follow the instructions below in order to send an email to your Senators and Representative. These emails are critical. If you have any questions, please contact your ACS staff in Washington, DC, at 202-337-2701 or ahp@facs.org.
Sincerely,
Patricia Numann, MD, FACS, President, American College of Surgeons
J. David Richardson, MD, FACS, Chair, Board of Regents
Andrew Warshaw, MD, FACS, Chair, Health Policy and Advocacy Group
David Hoyt, MD, FACS, Executive Director, American College of Surgeons
INSTRUCTIONS
Log in to http://www.capitolconnect.com/acspa/actionalerts.aspx with your ACS ID number and password. You will be directed to a pre-drafted email that you can edit and send to your Senators and Representative asking them to stop the 27.4 percent cut to Medicare physician payments before it goes into effect on January 1, 2012.
Contact Congress TODAY to urge them to stop the 27.4 percent cut to Medicare physician payments scheduled to go into effect on January 1, 2012, and permanently fix this broken system, by logging into the ACS Legislative Action Center at http://www.capitolconnect.com/acspa/actionalerts.aspx.
Dear Dr. Harris:
We are writing because we need your active involvement today. The American College of Surgeons has been advocating that the Joint Select Committee on Deficit Reduction, known as the "Congressional Super Committee," permanently fix the broken Medicare payment system as part of its larger effort. The Super Committee failed to reach its goal of saving $1.2 trillion and will not be addressing the physician payment issue.
Congress is scheduled to be in Washington until mid-December. There is a 27.4 percent cut in Medicare physician payment scheduled for January 1. The grim financial environment in Washington makes the likelihood of a cut to Medicare physician payments greater this year than in recent years.
The American College of Surgeons continues to strongly advocate for Congress to stop these cuts and repeal the SGR. However, Congress also needs to hear from the surgeons whose ability to practice and care for patients in their states and districts is being threatened by the failure to enact permanent reform of Medicare’s broken payment system. As a result, it is critical that ALL FELLOWS contact Congress TODAY and tell them to stop the cut.
Please follow the instructions below in order to send an email to your Senators and Representative. These emails are critical. If you have any questions, please contact your ACS staff in Washington, DC, at 202-337-2701 or ahp@facs.org.
Sincerely,
Patricia Numann, MD, FACS, President, American College of Surgeons
J. David Richardson, MD, FACS, Chair, Board of Regents
Andrew Warshaw, MD, FACS, Chair, Health Policy and Advocacy Group
David Hoyt, MD, FACS, Executive Director, American College of Surgeons
INSTRUCTIONS
Log in to http://www.capitolconnect.com/acspa/actionalerts.aspx with your ACS ID number and password. You will be directed to a pre-drafted email that you can edit and send to your Senators and Representative asking them to stop the 27.4 percent cut to Medicare physician payments before it goes into effect on January 1, 2012.
Sunday, December 4, 2011
Friday, December 2, 2011
Thursday, December 1, 2011
Wednesday, November 30, 2011
Tuesday, November 29, 2011
Thursday, November 24, 2011
Tuesday, November 22, 2011
Monday, November 21, 2011
Friday, November 18, 2011
Thursday, November 17, 2011
Wednesday, November 16, 2011
Sunday, November 13, 2011
Friday, November 11, 2011
Thursday, November 10, 2011
Wednesday, November 9, 2011
Tuesday, November 8, 2011
Monday, November 7, 2011
Sunday, November 6, 2011
Friday, November 4, 2011
Thursday, November 3, 2011
CMS Extends the Deadline to Tuesday November 8th to Apply for a Significant Hardship Exemption to Avoid the 2012 Electronic Prescribing Payment Penalty
The Centers for Medicare and Medicaid Services (CMS) has extended the deadline to apply for the significant hardship exemption to Tuesday, November 8th, 2011. If you missed the previous November 1st deadline, CMS has extended the deadline by one week, so it is still not too late to apply for the 2012 Medicare Electronic Prescribing hardship exemption. If you are an eligible professional who was unable to report at least 10 electronic prescriptions from January 1st to June 30th in order to qualify for the 2011 Medicare Electronic Prescribing Incentive Program, you may still receive a 1% penalty for the 2012 electronic prescribing payment adjustment. To avoid this penalty, eligible professionals and group practices participating in the group practice reporting option (GPRO) must apply by, Tuesday, November 8, 2011 for the 2012 Medicare Electronic Prescribing hardship exemption.
On September 6, 2011, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule: Medicare Program—Changes to the Electronic Prescribing (eRx) Incentive Program. The final rule made several key changes to the e-Prescribing program. The ACS was actively involved responding to the proposed changes to the eRx Incentive Program in order to reflect the concerns of surgeons attempting to comply with the program. We are pleased that CMS took into account many concerns raised by ACS, along with other organizations. While we continue to believe additional changes should be made to the program, we are encouraged that the current changes will help some surgeons to avoid the eRx penalty.
In order to assist you with the hardship exemption request process, we are providing a step-by-step guidance document that explains how to apply to for the hardship exemption http://www.facs.org/ahp/erx-exemption.pdf.
For more information on the Medicare e-Prescribing program and whether you are an eligible professional, please see the e-Prescribing article from the June issue of the American College of Surgeons Bulletin at: http://www.facs.org/ahp/pubs/whatsurg0611.pdf or contact the ACS Washington Office at 202-337-2701 or ahp@facs.org.
For additional information from CMS on the e-Prescribing program, please see http://www.cms.gov/erxincentive/.
For a copy of the Final Rule, please visit: http://www.gpo.gov/fdsys/pkg/FR-2011-09-06/pdf/2011-22629.pdf.
On September 6, 2011, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule: Medicare Program—Changes to the Electronic Prescribing (eRx) Incentive Program. The final rule made several key changes to the e-Prescribing program. The ACS was actively involved responding to the proposed changes to the eRx Incentive Program in order to reflect the concerns of surgeons attempting to comply with the program. We are pleased that CMS took into account many concerns raised by ACS, along with other organizations. While we continue to believe additional changes should be made to the program, we are encouraged that the current changes will help some surgeons to avoid the eRx penalty.
In order to assist you with the hardship exemption request process, we are providing a step-by-step guidance document that explains how to apply to for the hardship exemption http://www.facs.org/ahp/erx-exemption.pdf.
For more information on the Medicare e-Prescribing program and whether you are an eligible professional, please see the e-Prescribing article from the June issue of the American College of Surgeons Bulletin at: http://www.facs.org/ahp/pubs/whatsurg0611.pdf or contact the ACS Washington Office at 202-337-2701 or ahp@facs.org.
For additional information from CMS on the e-Prescribing program, please see http://www.cms.gov/erxincentive/.
For a copy of the Final Rule, please visit: http://www.gpo.gov/fdsys/pkg/FR-2011-09-06/pdf/2011-22629.pdf.
Wednesday, November 2, 2011
Tuesday, November 1, 2011
Monday, October 31, 2011
Friday, October 28, 2011
Wednesday, October 26, 2011
Tuesday, October 25, 2011
Monday, October 24, 2011
Friday, October 21, 2011
Thursday, October 20, 2011
Wednesday, October 19, 2011
Tuesday, October 18, 2011
Monday, October 17, 2011
Friday, October 14, 2011
Thursday, October 13, 2011
Wednesday, October 12, 2011
MedPAC Approves Physician Payment Plan, Overlooking Concerns About Offsets
MedPAC Approves Physician Payment Plan, Overlooking Concerns About Offsets
By Rebecca Adams, CQ HealthBeat Associate Editor
Even the American Medical Association (AMA), whose top priority is to eradicate the flawed formula, opposes MedPAC’s proposed fix.
“Offsetting part of the cost of repeal through drastic cuts and long-term freezes to physicians falls far short of what is needed to preserve patients’ access to care,” AMA President Peter W. Carmel said in a written statement.
Almost all health policy experts agree that the physician payment formula, known as the sustainable growth rate (SGR), does not work as intended. Congress has repeatedly staved off scheduled cuts in physician rates that were set by the formula. But the cost of permanently fixing the problem grows with every temporary reprieve. In January, the formula would result in a nearly 30 percent payment cut for physicians if Congress does not vote to prevent it.
The MedPAC recommendation would replace the problematic SGR formula with a 10-year fee schedule that would freeze primary care payment rates and cut rates for other providers by 5.9 percent for three years before freezing those payments as well. MedPAC included a list of offsets totaling $220 billion over a decade that Congress might consider to pay for the new physician payment rates. About 34 percent of the funding for the changes would come from the drug industry; 21 percent from post-acute care, such as skilled nursing facilities and home health agencies; 15 percent from higher cost-sharing by beneficiaries; and 11 percent from hospitals.
Representatives of medical providers — who packed the room so tightly that a number of people had to stand — were not happy with the proposed cuts. They had expressed concerns about the proposal when it was unveiled. Several groups had written letters also opposing the plan.
Only two commissioners — Karen Borman, director of the Surgical Residency Program of Abington Memorial Hospital in Pennsylvania and Ronald Castellanos, a urologist with Southwest Florida Urologic Associates — voted against the MedPAC recommendation.
Castellanos noted that under the plan, a nurse practitioner would be eligible for higher Medicare payment rates than a physician specialist, a prospect that he called “extremely disturbing” because he said the average urologist has undergone about 17,000 hours of training while a nurse practitioner has had no more than 1500 hours.
Castellanos said that specialists who face a growing number of government regulations and declining payment rates are going to ask themselves: “Is it worth it for me to stay in practice?
“I think there are going to be a lot of doctors like myself who are going to say it’s just not worth it anymore,” he added.
During the deliberations on the plan, many commissioners expressed reservations about the proposal, especially the offsets.
Several said that the list of offsets should not be seen as a recommendation from MedPAC that Congress consider those specific policies to reduce spending growth. In fact, some said they had problems either with some of the precise offsets or with the overarching idea that all of the cuts should come from Medicare rather than other types of government spending. But all of those who voted to approve the recommendation said the time had come to finally stop passing one-year changes to the physician payment formula, and that goal overcame their reservations about the offsets.
In a PowerPoint presentation, MedPAC staff noted, “Offsetting the cost within Medicare compels difficult choices — both in offsets and in fee reductions — that MedPAC may not support outside of the context of repealing the SGR system.”
After the vote, lobbyists and other representatives of physicians and other medical professionals lined up to express their unhappiness. Even though most of them expressed support for ditching the current SGR formula, they argued that the costs should not be borne by Medicare providers. Many types of providers are already preparing for other cuts that were in the 2010 health care overhaul (PL 111-148, PL 111-152) and may face additional cuts if Congress passes them this year as part of legislation to reduce the deficit. Two speakers said the medical profession should not pay for higher-than-scheduled payment rates for physicians because providers did not create the flawed formula — Congress did.
“For almost everyone in this room, it’s been kind of a disheartening morning,” said Barbara Tomar, director of federal affairs for the American
The draft recommendations were:
• “The Congress should repeal the sustainable growth rate and replace it with a 10-year path of statutory fee schedule updates. This path is comprised of a freeze in current payment levels for primary care and for all other services, annual payment reductions of 5.9 percent for three years, followed by a freeze. The commission is offering a list of options for the Congress to consider if it decides to offset the cost of repealing the SGR system within the Medicare program.” Approved 15-2.
• “The Congress should direct the secretary [of Health and Human Services] to regularly collect data — including service volume and work time — to establish more accurate work and practice expense values. To help assess whether Medicare’s fees are adequate for efficient care delivery, the data should be collected from a cohort of efficient practices rather than a sample of all practices. The initial round of data collection should be completed within three years.” Approved 17-0.
• “The Congress should direct the secretary to identify overpriced fee-schedule services and reduce their RVUs accordingly. To fulfill this requirement, the secretary could use the data collected under the process in recommendation 2. These reductions should be budget neutral within the fee schedule. Starting in 2015, the Congress should specify that the RVU reductions should achieve an annual numeric goal — for each of five consecutive years — of at least 1 percent of fee-schedule spending.” Approved 16-1.
• “Under the 10-year update path specified in draft recommendation 1, the secretary should increase the shared savings opportunity for physicians and health professionals who join or lead two-sided risk ACOs. The secretary should compute spending benchmarks for these ACOS using 2011 fee-schedule rates. Approved 15-1, with one abstention.”
Tuesday, October 11, 2011
Monday, October 10, 2011
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