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1. Medicare Proposes 9.9% Physician Payment Cut
The Centers for Medicare, Medicaid Services (CMS) last week announced it would cut physician payments by nearly 10 percent in 2008. Despite a recommendation from the Medicare Payment Advisory Commission (MedPAC) that doctors payment rates be increased by 1.7 percent in 2008, CMS was required to slash rates because of the flawed sustainable growth rate (SGR) formula.
For the past five years, it's been an annual cycle: CMS proposes pay cuts and outraged physicians and medical associations demand that Congress reform the broken payment system. Unable to come to an agreement on a long-term fix, Congress then acts at the last minute to stop the cuts. What makes this year different is the magnitude of the cut. Doctors face a 9.9 percent cut in 2008 because Congress blocked the scheduled cuts over the past five years, increasing rates 1.6 percent in 2003 and 1.5 percent in 2004 and 2005. Congress froze rates in 2006 and 2007.
Physicians must contact their members of Congress and tell them to stop the 10 percent cut, says CMA President Anmol S. Mahal, M.D. Physicians cannot sustain such an enormous cut when our rates are already less than those paid by Medicare in 2001.
If Congress fails to reform the flawed payment formula, projections have physician reimbursement being cut by roughly 40 percent over the next nine years. Practice costs are expected to increase 20 percent during that same time period.
CMA recently submitted to Congress a multipronged proposal to overhaul the broken payment system. The proposal would, among other things, eliminate the SGR formula and provide payment updates based on actual practice cost increases.
Democratic leaders in the U.S. House of Representatives are feverishly working on legislation that incorporates many elements from CMA's reform proposal. Their plan would stop the 10 percent physician pay cut and institute payment increases for two to three years or until a long-term alternative to the SGR payment system can be crafted. The legislation would also fund the reauthorization of the Healthy Families program that has covered uninsured children in California for nearly a decade.
These reforms would be paid for by increasing the tobacco tax, which would raise $35 billion, and equalizing Medicare Advantage health plan rates with fee-for-service rates. Currently, Medicare Advantage plans receive on average 12 percent more than fee-for-service physicians for providing the same services to Medicare beneficiaries. Bringing plan rates in line with fee-for-service physician rates could save as much as $65 billion. This legislation could come up for a vote in the next few weeks. '
Please contact your members of Congress immediately and tell them to support Medicare payment reform. Call AMA’s grassroots hotline at 800/833-6354, enter your zip code when prompted and you will be automatically connected with your representative.
Click here for more information, including talking points.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. AMA Sets Policy on Emergency Contraception, Advance Health Care Directives, and Underage Drinking
The California delegation to AMA's House of Delegates presented a number of important resolutions at the association's annual meeting in Chicago. The following are summaries of some of the resolutions that the AMA House adopted as policy.
Electronic Advance Health Care Directives: The AMA delegates adopted a California resolution calling on AMA to advocate for national implementation of secure electronic advance health care directives.
Access to Emergency Contraception: The delegates voted for AMA to urge that established emergency contraception regimens be approved for over-the-counter access to women of reproductive age. The resolution also urges that pharmacies be required to inform the public (via their websites or other means) whether they stock and dispense emergency contraception, and if not, provide information on where it can be obtained, either with or without a prescription.
Definition of Usual, Customary, and Reasonable (UCR): The delegates adopted a California resolution that established following definitions for Usual, Customary, and Reasonable fees.
- Usual fee: A “usual” fee is that usually charged by an individual physician to his private patient for a given service.
- Customary fee: A fee is “customary” if it falls within the range of “usual fees” currently charged by physicians of similar training and experience, for the same service, within the same geographical area; and
- Reasonable fee: A fee is “reasonable” when it meets the above two criteria and is justifiable, considering the special circumstances of the particular case in question, without regard to payments that have been discounted under governmental or private plans.
Prevention of Underage Drinking: The delegates called for a ban on the marketing of products such as alcopops, gelatin-based alcohol products, food-based alcohol products, alcohol mists, and alcoholic energy drinks that have special appeal to youths under the age of 21.
Click here for more information.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
3. Monday Is Deadline to Update NPI Data Before It Goes Public
The Centers for Medicare, Medicaid Services recently announced physicians National Provider Identifier (NPI) data would be made publicly available online via a searchable database.
Although CMS originally planned to unveil the NPI lookup tool on June 28, the agency has decided to delay the launch to allow physicians and other covered entities additional time to ensure that their information is accurate before it is disclosed by CMS.
Covered entities can review their information at the NPI enumerator's website, https://nppes.cms.hhs.gov. The deadline to make any changes is this Monday, July 16.
The online lookup will return NPIs and relevant demographic information, but it will not disclose Social Security numbers, dates of birth, or IRS taxpayer identification numbers, according to CMS.
Click here for more information.
Contact: CMA's Reimbursement Help Line, 888/401-5911.
4. CMA Foundation Seeking Nominations for Annual
Leadership Achievement Awards; Deadline Is July 16
There's still time to submit nominations for the CMA Foundation's annual leadership awards, the Robert D. Sparks, M.D., Leadership Award, the Ethnic Physician of the Year Award, and the Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award. Nominations must be postmarked by July 16.
The winners will be honored at the CMA Foundation's Annual Leadership Dinner, held October 28 in Anaheim, during the CMA House of Delegates. Recipients will receive a plaque and a $1,000 honorarium. The ethnic physician award also includes a $1,000 grant for the ethnic physician organization of the honoree's choice.
Click here for more information.
Contact: Carol Lee, 916/551-2562 or clee@cmanet.org.
5. Member Benefit of the Week: Workers'; Comp Insurance
Don't renew your workers' compensation policy without first checking with CMA's affinity partner, Marsh. Rates have dropped significantly in the past year, and qualifying members are eligible for additional savings when they purchase or renew their policies through Marsh. Call Marsh at 800/842-3761 for information.
Click here for more information on your membership benefits.
Contact: CMA’s membership hotline, 888/233-2937 or lgodward@cmanet.org.
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