Thursday, November 09, 2006

Gov gives with one hand and takes away with the other

On November 1, the Centers for Medicare and Medicaid Services (CMS) issued its final rule for the 2007 Physician Fee Schedule. The rule increases Medicare relative value units (RVUs) for office visits and other undervalued evaluation and management (E/M) services. The RVUs are one of the factors that Medicare and many other payers use in setting their pay rates. The RVU increases will result in Medicare paying approximately $4 billion more for E/M services than it has in the past. CMS’s decision to increase the RVUs was due in large part to the College’s efforts, supported by other physician organizations, to document that the typical complexity and work involved in these services has increased substantially.
Regrettably, though, the initial beneficial impact for patients that result from paying more for personalized, primary care services will be undermined because of Congress’ inexcusable failure to act to avert a 5 percent cut mandated by the flawed sustainable growth rate (SGR) formula. In fact, CMS now projects that the SGR cut will more than cancel out the 2007 dollar improvements internists would have received from the RVU increases.
The 5 percent payment cut results from the SGR formula, which was created in 1997 and ties physician payment to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. This results in an across-the-board cut in Medicare payments to physicians.
The College agrees with CMS that by paying physicians more for the time they spend talking with patients about their health care and by emphasizing personalized care, patients will benefit from better outcomes and more efficient use of resources. The College also believes that the improved RVUs, if not offset by the Medicare SGR cut , would begin to address long-standing inequities in how Medicare pays for services that are contributing to the imminent collapse of primary care medicine in the United States.
One result of the SGR cut is that many internists, who are already struggling to keep their practices open, will find that Medicare payments will continue to fall behind their costs. A new 2006 randomized survey of ACP’s membership found that if a 5 percent cut goes into effect, 27.6 percent of those surveyed will decrease the number of new Medicare patients accepted into their practices; almost 40 percent of those who are self-employed or in private practice reported that they would decrease the number of new Medicare patients they would accept . Other specialties will experience even larger reductions in Medicare payments, which will also lead to reduced beneficiary access.
It is not too late, however, for Congress to act to avert the SGR cut and assure that internists and your Medicare patients get the full benefit of the RVU increases for E/M services.
Congress will be returning in a matter of days for a post-election “lame duck” session to complete action on “must pass” legislation before adjourning for the year. We need your help to assure that legislation to halt the SGR cuts is among those “must pass” bills.
We ask you to help us prevail upon each and every member, including those in the congressional leadership and on Medicare authorizing committees, to enact legislation to:
Halt the 5 percent cut in Medicare payments that will result from a flawed SGR formula and replace it with a positive update, and
Support implementation, without delay, of CMS’s final rule to increase Medicare relative value units (RVUs) for office visits and other undervalued evaluation and management (E/M) services.
Each and every member of Congress is critical – we need your help today. Time is of the essence as Congress will reconvene this coming Monday, November 13 and may only remain in session for a few days. Please take a few minutes and use ACP’s Legislative Action Center (LAC) to contact your members of Congress, . [To logon, use your email address as the username and ACP as the password, unless you’ve personalized it.] A sample message is available for you to personalize and forward to your federal lawmakers. Different messages are posted for medical students, associate members, and internists. Even better, please take a few minutes to call your members of Congress in their Washington offices. Use AMA’s toll-free grassroots hotline at 1-800-833-6354 and press 1, then enter your zip code and ask for the member’s health legislative aide. If you have problems, please contact Tracy Novak at or by phone at 800-338-2746 ext. 4532.
Many thanks to those of you who contacted your legislators previously this year but I urge you to contact them again now. Many of you were told by your lawmakers that they would fix the SGR problem after the elections – we must hold them to that promise. Without immediate Congressional action, primary care will suffer and the intended improvements for patients that would result from emphasizing the value of personalized, primary care will not be realized. We work too hard to provide the best care possible to our patients – we can’t let Congressional inaction change the paradigm. Thank you in advance for your help.
Lynne Kirk, MD, FACPPresident, ACP

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