Medicare payment reform, a primary care physicians perspective
I forward this letter from the president of the American College of Physicians. We urge everyone to contact their representatives and Senators so that we can resolve these problems with Medicare
Dear Colleagues:
I write to you today for three reasons: to introduce myself as your new ACP President, to share what ACP is doing to influence Medicare payments and implementation of health reform, and to announce a major new resource for internists on the "nuts and bolts" of the new law.
A little more than eight weeks ago, I was humbled, honored and privileged to take the baton from my good friend, Doctor Joe Stubbs, to become the President of the American College of Physicians. In my mind, there is nothing more rewarding than being a spokesperson for internists and our patients through ACP.
When I am not speaking for ACP, I am practicing general internal medicine in an eight-physician private practice in Fayetteville, Tennessee, with admitting privileges in the successor to the sole community hospital in which I was born. Like you, I see the direct consequences of misguided government and insurance industry actions on patients, including the havoc resulting from the 21% Medicare and TRICARE cut that went into effect on June 1. Because Congress refused to act in time, claims weren't paid for 18 business days, Medicare started processing the claims with the 21% cut, and patients and physicians alike were left wondering if and when payments would be restored.
Last week, ACP issued a statement to express internists' collective frustration. I hope you will read it, share it with colleagues, and take the following message back to the politicians -- especially next time they ask for your vote!
"It is past time for politicians from both political parties and both chambers to stop blaming someone else for the impasse. Physicians and patients don't want to hear that it is the Democrats' fault, or the Republicans', or the President's, or the Senate's, or the House's. They don't want to hear politicians claim that they are for repealing the SGR, as they withhold their vote from any practical plan to achieve repeal. They want to hear that the people they elected can work together to solve the problem."
What is particularly galling is that late in 2009, we came closer than ever to permanent SGR repeal. With ACP's backing, the House of Representatives voted in November to repeal the SGR, provide higher updates for all services, and allow for an additional increase for primary care visits and preventive services. But the Senate, which requires 60 votes to pass just about anything, refused to take it up.
Then, a few weeks ago, ACP worked with the House and Senate leadership to develop a proposal to provide up to five years of positive updates for all services, with an additional increase for office and other evaluation and management services—providing the longest period of stable and positive payments since the SGR was enacted 13 years ago. On May 26, ACP participated in a joint press conference with the AARP, American Academy of Family Physicians, American Osteopathic Association, and the Military Officers Association of America to urge Congress to support the proposal.
But instead of adopting this common-sense approach to stabilize payments for many more years and to begin to move to a better payment system for all services to replace the SGR, partisan gridlock and finger-pointing ended up carrying the day.
In the end, the only thing that Democrats and Republicans could agree on was another short-term patch -- a 2.2% update retroactive to June 1 and extending through November 30. This was too little, too late to undo the harm done to Medicare.
ACP will continue to press Congress to reach agreement on a bipartisan, bicameral plan to lead to a permanent end to the cycle of Medicare payment cuts. I plan to hold my representative and Senators accountable, and I hope you will as well.
Now, let me share developments relating to the health reform law. Even as the political debate continues, we are in a new phase, with federal agencies issuing rules to implement the changes made by the Patient Protection and Affordable Care Act. On Friday, CMS issued a proposed rule to implement a new Medicare 10% bonus for office visits by internists and other primary care physicians, a new annual Medicare risk assessment visit, and elimination of cost-sharing requirements for Medicare-covered preventive services.
Earlier this month, the administration released $250 million to fund the training of more general internists and other primary care clinicians. It announced plans to fund multi-payer Patient-Centered Medical Home demos in up to six states.
ACP is providing detailed and specific recommendations on each of these initiatives, and the many more coming down the pike.
Also, nominees are being sought for two important federal advisory committees created by the law. One will recommend federal policies to achieve a health care workforce that meets societal needs, including examination of barriers to primary care careers, and another will direct the federal government's research on the comparative effectiveness of different treatments. ACP is seeking appointment of several superbly qualified ACP members to these bodies.
With all of the changes taking place, you may wonder, then, how can you keep pace?
ACP has the answer. Wednesday morning we released a brand new publication, An Internist's Practical Guide to Understanding Health System Reform. The guide, which is available here for a free download to your computer in an easy-to-use and searchable PDF format, provides clear, concise, and unbiased explanations of changes made by the law and when they go into effect. You can learn about this year's changes in insurance market rules; changes to be made in 2011 in Medicare's preventive and prescription drug benefits and primary care payments; new opportunities for medical students to apply for loan forgiveness and scholarships; new grants to medical schools and IM residency programs; and much, much more -- with the most important changes for internists described all the way through 2015. Whether you agree with the health reform law or not, I think you will find An Internist's Practical Guide to Understanding Health System Reform to be the single most comprehensive, clear, and objective explanation of the new law, and what it might mean for internists and their patients.
As your ACP president, I promise you that I will do all that I can to speak for you and your patients, grounded as always in my own experience as a practicing internist in rural Tennessee. Whether it is pressing Congress to end the cycle of Medicare SGR cuts, influencing implementation of health reform to ensure that our views are heard, or providing you with the best information available on the new law, you can count on ACP to be a dedicated advocate for you and your patients.
Yours truly,
J. Fred Ralston, Jr. MD, FACP
President
President
Richard Bernstein M.D. F.C.C.P.
