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Wednesday Dec 21, 2011

Congress Fails Medicare Patients and Their Physicians

In a disgraceful display of partisan politics, Congress has put the health care of the more than 47 million Americans covered by Medicare and the practices of the physicians who care for those patients in jeopardy. Barring last-minute heroics -- which seem increasingly unlikely from the least-popular Congress in the history of the Gallup poll -- physicians face a 27.4 percent Medicare payment reduction that is scheduled to take effect on Jan. 1.

Congress is receiving a failing grade from the AAFP regarding its actions on the Medicare payment situation. Although the majority of Republicans and Democrats in the House and Senate agree on the need to extend a payroll tax cut that affects 160 million Americans, extend benefits for millions of long-term unemployed, and -- most importantly to this audience -- maintain the current level of Medicare payments to physicians, they cannot agree on a solution.

Given an opportunity to address all three of these issues in the waning days of 2011, legislators accomplished exactly what you might expect from a group with an approval rating approaching single digits -- nothing.

So how did we get in this position?

On Dec. 20, the U.S. House of Representatives rejected a bill -- which had passed through the Senate with overwhelming bipartisan support -- that would have delayed an impending Medicare payment cut and extended the tax break and unemployment benefits for two months. The Senate bill was unacceptable to House Republicans because it offered only a short-term solution to problems that would have to be addressed again early in 2012.

A week earlier, the House had approved a bill that would have provided a 1 percent increase in Medicare physician payments for each of the next two years. However, the House bill was unacceptable to Senate Democrats because it also would have repealed or scaled back programs in the Patient Protection and Affordable Care Act.

Legislators from both sides of the aisle are behaving like children in a playground squabble, pointing fingers and calling names while their constituents suffer the consequences of their ineffectiveness.

The Senate already had adjourned for the holiday break when the House rejected the Senate's short-term solution and is not expected to return until Jan. 23, making it unlikely that the Medicare payment cut will be averted.

Although the Senate's two-month fix is not at all what the Academy wanted for the holidays -- or what it had been demanding -- it would have been better than the giant lump of coal the House has left us with. Whatever action Congress takes likely will be retroactive, creating billing nightmares for physicians and CMS, which has issued guidance instructing Medicare carriers to hold payments until at least Jan. 17 to give Congress additional time to reach an agreement.

Of course, Congress has had nearly a decade to solve this problem, passing short-term fixes to the sustainable growth rate, or SGR, formula every year from 2003 through last year. This year, lawmakers couldn't even manage to put another Band-Aid on the problem.

For those of you who are asking about your options regarding participation in the Medicare program, the AAFP has resources available online.

Many of you have been actively involved in our grassroots efforts on this issue. In fact, 2,443 of you sent 6,208 letters to your members of Congress during the past two months regarding the SGR and funding for Title VII programs and graduate medical education. I want to thank you. It will be imperative that legislators hear from us when they return to work in January. Congress needs to know how the Medicare payment cut will affect your practice and your patients' access to care. Nearly one-fourth of patients seen by family physicians are Medicare beneficiaries. For some of you, the percentage is much higher.

What's your story? Be ready to tell your legislators.

I am not asking you to contact your elected officials immediately (they're not there to answer your call or read your e-mail), but the Academy will be calling on members for an all-out effort to make our message heard early next month. I will provide you with details when it's time to act.

I want to emphasize that although a short-term solution will be needed to stabilize Medicare payments, the AAFP remains committed to its long-standing demand for a permanent fix. We are calling for a repeal of the SGR, a period of at least three to five years of payment stability, and at least a 3 percent positive payment differential for primary care compared to other specialties.

Our resolve hasn't wavered, and with your help, we will persevere to achieve this goal.



Sorry, your post is "disgraceful" in my opinion. You know the issue in the delay is NOT about Medicare payments. The delay is a dispute about payroll taxes. Both the house and the senate have approved Medicare payment extensions and WILL once the tax issue is settled. You choose to throw gasoline on the fire, but I do not support you.

Posted by Glenn Jennings on December 22, 2011 at 02:33 PM CST #

Thank you Glenn for your post. You are correct that both the House and Senate have passed bills that include an SGR fix. But they must both pass the SAME bill for it to go to the President for signature and then take effect. They have not done this and are currently not close to doing so. They differ on the length of the fix and more significantly on how it will be funded. They are using the funding for the fix as a partisan political issue. Both House and Senate, both Democrats and Republicans are responsible for this mess. As the situation currently stands, the Medicare physician payment cut will go into effect January 1st and physicians will begin to feel the effect January 17th once the CMS hold on payments ends. Physicians didn't start this fire, Congress did. I am not throwing gas on the fire, I'm highlighting the seriousness of the fire and promoting our Academy's approach to putting out this fire once and for all.

Posted by Glen Stream, MD on December 22, 2011 at 03:19 PM CST #

I am becoming more and more convinced that we (physicians in general and FPs in particular) are in the role of a codependant battered spouse. We keep trying to change our abusers (government, insurance companies) and waiting for whatever crumbs they will throw us. I have done a lot of contemplating over the last several months about what it would be like if we all stood up for ourselves and said we're not going to take it anymore. Stop playing the game. It takes a lot of creativity and thinking outside the box and bucking the established ways of doing medicine and politics and business. What if the AAFP worked more on helping members "vote with their feet?" Opt out of Medicare and other payors. Cash only or retainer practices. Of course what is at stake is the millions of Americans with Medicare coverage who already have trouble accessing healthcare because of how Medicare pays doctors. It's hard to advocate for abandoning them...but the situation is completely untenable now and these temporary fixes are just crumbs from the table and we're behaving like hungry dogs, dutifully waiting for whatever our master will throw our way. I know this sounds very harsh, in some ways. But I'm really really really tired of this whole fight because it is really putting us into the role of victims. There has to be another way. I don't want to keep reading about how we are disappointed with Congress because they failed to "delay" our pay cut. What other profession has to fight like this to get paid? It's ridiculous. I don't know what the answer is but I know it's not to keep on waiting for more crumbs and it's not to stay in an abusive relationship.

Posted by Rebecca Canner, MD on January 02, 2012 at 02:01 PM CST #

In response to Rebecca's comment: I've been using the "lifetime for women movie" (battered-spouse) analogy for years, and i cannot tell you the freedom that i felt when i disentangled from the insurance contracts (which was a battle of its own). I now have a successful but small cash practice, but would like to go back to at least non-par status with medicare, because i know that paying me cash is a hardship for many of my senior citizen patients on fixed incomes. BUT I CAN'T DECIDE WHAT TO DO UNTIL THEY DECIDE WHAT THEY ARE GOING TO PAY! Because now that I don't deal with insurance companies, I decide what I get paid, I am able to look at expenses vs number of patients seen vs value of my time and effort and determine what to charge. Its a novel concept, but it works for every other business, why not medicine? So before I can decide whether to resign with Medicare, I need to know if they are going to pay me what I need. Just like anyone else making any other kind of financial decision. But like so many young docs when i got out of school, i signed at the dotted line and took what i was given. Never again.

Posted by tac crowley on January 03, 2012 at 11:13 AM CST #

Thanks Rebecca and Tac, I certainly understand and share your frustration with the current state of treatment of family physicians by both government and private payers. I don't share your view that we are codependent in this confrontation. I believe we have progressively stood up for ourselves, our goals have not yet been achieved but that simply means we need to continue these efforts. I understand your “vote with your feet” perspective. This is a decision that must be made at the level of the individual physician and practice. Any collective AAFP effort of this type would violate anti-trust laws with grave consequences to our Academy. Please see my discussion on this issue from a prior blog post, http://blogs.aafp.org/cfr/leadervoices/entry/a_powerful_voice You are absolutely right that as a member organization representing family physicians we must provide the resources for each of us to consider our options regarding Medicare. This is available on the AAFP website, Medicare Participation Options for Physicians http://www.aafp.org/online/en/home/practicemgt/mcareoptions.html It’s understandable to be discouraged, but don’t lose hope. I remain optimistic that working together, we will achieve a future where family physicians are treated and compensated appropriately.

Posted by Glen Stream, MD on January 06, 2012 at 09:56 AM CST #

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