Hundreds of thousands of doctors who participate in traditional Medicare face a 24 percent pay cut on April 1, as part of a 1990s initiative to restrain federal spending on the government healthcare program, which today serves nearly 50 million elderly and disabled people.
Using language seldom reserved for Congress, the nation’s most powerful lobbies for physicians are heaping praise on rare bipartisan legislation heading to the floors of the U.S. Senate and House of Representatives perhaps within the next month to fix a flaw in how doctors are paid by the federal Medicare health insurance program for the elderly. After years of watching Congress delay, debate and dither on the repeal of Medicare’s “sustainable growth rate,” or SGR, reimbursement formula, a solution has passed three powerful Congressional committees and is headed possibly next month to likely passage.
According to the story in Forbes, the deal, which both the American Medical Association and the American Academy of Family Physicians have called a “bicameral, bipartisan” agreement to repeal SGR would bring an end to stopgap corrections to dramatic cuts in doctor payments from Medicare in what has since been labeled the “doc fix.” At the same time, the legislation heading for Senate and House votes would tie more physician reimbursement to quality and outcomes measures. “Legislators and staff have shown a Herculean effort in crafting this proposal,” Dr. Jeffrey Cain, chair of the American Academy of Family Physicians board said in a letter Monday to Congressional leaders including House Speaker John Boehner and Senate Majority Leader Harry Reid.
Congress has several times for a decade now merely made stopgap corrections to avert drastic payment cuts to Medicare payments under SGR, which was created by the Balanced Budget Act of 1997 in an effort to slow the growth of Medicare spending. Last year alone, Congress averted a fee cut of nearly 27 percent to physician payments. The AMA, family doctor group and other physician lobbies say Congress needs to act before March 31 when the latest stopgap measure that extends “the Medicare payment formula that includes the Sustainable Growth Rate expires,” Cain said. “The looming threat of frequent reductions also stifles innovation in case delivery and hinders the transformation of primary care practices,” Cain said. “Investments in process and quality improvement have proven difficult for most physicians under the current unpredictable payment structure.”
Should the legislation pass, it will increase payments 0.5 percent annually through 2018. Meanwhile, more Medicare payments would be tied to quality measures that include “clinical care, safety, care coordination, patient and caregiver experience and population health.” To get bonus payments, physicians would be compared to their peers and measures would be updated every year by the U.S. Secretary of Health and Human Services.
The move to new payment could also be good news to the health insurance industry with companies like Aetna, UnitedHealth Group, Humana and others seeing greater numbers of seniors flocking to their Medicare Advantage plans that contract with the Medicare program to provide seniors with health benefits. They need doctors to participate if they are going to provide seniors with adequate medical care provider networks.