Dysfunctional Congress Again Fails to Stop Medicare Physician Payment Cuts
[Posted 09/28/06]

Congress will adjourn on Friday without having fixed the Medicare physician payment problems. Although Congress will briefly reconvene after the November elections, these lame-duck sessions have historically been short and unproductive, making it unlikely that they will agree to a solution in time to avoid the 5 percent physician payment cut scheduled to take effect January 1.

"We are extremely disappointed and angry that Congress failed to stop the 5 percent physician payment cut while the hospitals and health plans get their 3 to 7 percent increases,” says CMA President Michael Sexton, M.D.

"CMA, the county medical societies, and California's physician grassroots did everything humanly possible to convince Congress to stop the cuts and institute a payment update. Despite the efforts of Ms. Johnson and other California Republicans, the Republican leadership didn't come through and does not apparently see this issue as a priority to address before the November elections,” says CMA CEO Jack Lewin, M.D. "They don't believe that physicians will really pull out of the program, and none of the recent national studies have demonstrated significant access problems in the Medicare program. Moreover, the cost to fix the problem is more than $200 billion. These perceptions about access combined with the enormous cost to the federal budget spells inaction.”

Unfortunately, the Republican leadership in the House and Senate could not agree on a plan to stop the physician payment cuts. In September, a number of congressional leaders—including Bill Thomas (R-Calif.), Nancy Johnson (R-Conn.), and Charles Grassley (R-Iowa)—developed last-minute proposals to stop the cuts, but none provided a viable solution to the broken payment system. The proposals included minimal payment updates (0.5 to 2.5 percent), payment reductions for providers who do not meet major new quality reporting requirements, and financing schemes that would have subjected physicians to cuts of up to 10 percent annually in future years.

CMA urges physicians to meet with their members of Congress to express their outrage and extreme disappointment that the Republican-led Congress again failed to fix the physician payment problem. They need to understand that this is an urgent issue and that failure to reform the Medicare payment formula will force physicians to stop accepting new Medicare patients or withdraw from the program entirely. Also tell them that any credible pay-for-performance quality-reporting program must provide for strong physician input on how "quality” is defined and measured, ensure that physicians are appropriately reimbursed, and provide IT support so that physicians can afford to participate in such a program.

Although fixing the SGR is CMA's top Medicare priority, the association continues to urge Congress to fix the outdated geographic payment localities and to do so before the geographic practices cost index is updated next year.

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