Responding to consistent and widespread concern over proposed cuts to physician Medicare payment rates, the lame-duck Congress passed on its last day, Dec. 9, legislation preventing cuts through 2007.
In addition, Congress extended the geographic price cost index to prevent additional payment cuts for physicians in rural areas.
According to American Medical Association Board Chairman Cecil B. Wilson, MD, nearly 1 million patients and physicians contacted Congress to urge action on this issue. The decision to block the cut "provides an important but temporary reprieve for seniors and the physicians who care for them," he said, because many physicians threatened to drop from the Medicare program if faced with payment cuts.
AMA considers this fix "far from ideal," Wilson said. It does recognize, however, that when doctors and patients work together, they can be effective in forcing change. "[Averting] an across-the-board payment cut in a difficult legislative environment should give hope," Wilson said.
Rick Kellerman, MD, president of the American Academy of Family Physicians, said the AAFP attributes the temporary fix to physicians' pressure on Congress. "We got the sense this year when we were talking about the sustainable growth rate [a payment formula that affects how physicians are paid] that they were tired of talking about it," he said.
The AAFP now hopes that Congress will pass a permanent fix before 2008. In March 2007, the Medicare Payment Advisory Commission, a Congressional advisory panel, will issue a report that doctors hope will offer some definitive ways of fixing the underlying formula, Kellerman said.
"I think there's a developing understanding of the importance of primary care," he said. "Whatever the payment structure, it needs to incentivize patients to get the right care at the right time. The current payment structure for physicians doesn't really do that. We need to look at the health of patients and how we can most cost-effectively improve care."
The Medical Group Management Association is pleased with Congress' bipartisan effort to stop the cut in the short term, said Pat Smith, MGMA's senior vice president of government affairs.
"Congress understands the magnitude of the issue, what was done was a short term stopgap measure," Smith said. "Rep. Pete Stark (D-Calif.), ranking Democrat on the Ways and Means Health Subcommittee, has already said that he understands that the formula for paying physicians under Medicare doesn't work, and that is going to provide a good opening discussion point as to how we fix it."
The MGMA is not the only organization that plans to leverage discussion on the issue beginning as early as Jan. 3. "The time is long overdue to devise a sound financing system for the Medicare program so we can avoid this annual struggle to preserve seniors' access to care," said the AMA's Wilson.
Hill staffers and physician organization lobbyists agree that Congress is sympathetic to physicians but not to a growing federal deficit. There is strong talk on Capitol Hill that the Democrats would like to reinstate the 2002 pay-as-you-go policy that was responsible for healing some of America's budget woes in the recent past. This policy requires no increases in spending. New policies must be funded by existing money.
"Where we are going in this country on entitlement spending is an issue that we have to face up to," said Mark Hayes, health policy director for former Senate Finance Committee Chairman Chuck Grassley (R-Iowa), at a recent legislative briefing. "To sustain Medicare it is going to take possibly restructuring benefits or an increase in taxes - and these are not easy decisions to make."