A CMA delegation was in Washington this month imploring federal lawmakers and Administration officials to fix the Medicare physician reimbursement problem. The CMA delegation of physicians and staff met with dozens of Members of Congress and key officials from the White House and the Centers for Medicare & Medicaid Services (CMS).

CMA continues to advocate for a long-term fix for the flawed sustainable growth rate (SGR) formula, which allows total Medicare spending on physician services to grow at the rate of the gross domestic product (GDP), but actually penalizes physicians, in part because the cost of physician services rises more rapidly than the GDP. The SGR formula also does not adequately account for the increase in beneficiaries or the cost and complexity of new medical procedures.

CMA believes the SGR formula should be scrapped immediately, and that Congress should direct the Medicare Payment Advisory Commission (MedPAC) to spend the next two years coming up with a fair and more effective physician payment formula for implementation by 2009. In the meantime, CMA urges Congress to follow the recommendations of MedPAC, an independent federal commission established in 1997 to advise Congress on Medicare issues. MedPAC has recommended a 2.8 percent increase in physician payment for 2007.

CMA leaders also urged CMS officials to fix Medicare’s geographic payment inequities. The Medicare fee schedule adjusts payments for physicians based on their geographic practice cost differences (i.e., rent, supplies, staff). However, physicians in 32 states and 175 counties are paid 5 to 14 percent less than their Medicare-assigned geographic cost factors. The reason? These counties are placed inappropriately by Medicare in geographic payment localities with counties that have lower practice costs. Medicare could reassign these counties, but federal budget neutrality laws would result in 4 to 6 percent rate reductions forrural physicians.  CMA is seeking legislation that would help these underpaid counties while protecting rural counties from a cut.

CMA also lobbied to protect graduate medical education funding for pediatricians and disadvantaged minority students and participated in a roundtable discussion with House Democratic leadership to discuss CMA’s strategies for achieving universal health care coverage. The roundtable was sponsored by California Representative Xavier Becerra (D-Los Angeles).

Click here to download CMA's Federal Issues Summary.

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.