Further Actions to Take to Stop the Medicare Cuts Now!

1. CMA Tells Congress: Action Needed to Stop Medicare Crisis
2. Physicians: Take Action to Stop the Medicare Cuts Today!
3. Stay Engaged: Become a CMA Legislative Key Contact
4. CMA Comments on Medicare’s Physician Value-based Payment Modifier
5. Key Committee Chairmen Join CMA in Opposing Medicare Geographic Payment Changes

1. CMA Tells Congress: Action Needed to Stop Medicare Crisis [top]

CMA, AMA, medical societies representing all 50 states and the District of Columbia, along with 65 national physician specialty organizations, united to send a strong message to Congress: Immediate action is needed to stop the drastic 30% Medicare payment cuts looming at the end of this year. Without action to stop the cuts during the congressional lame duck session the first part of November, Congress will create a Medicare meltdown that will threaten access to care for seniors and military families.

Congress has repeatedly failed to fix the flawed Medicare physician payment formula, relying instead on temporary reprieves from scheduled cuts. The latest of these temporary delays stabilized Medicare physician payments only through the end of November. If action is not taken by Congress during the November lame duck session, Congress will not return until February 2011. Medicare payments for physician services will be delayed and reduced for at least three months, cuts of more than 23% will take effect on December 1, 2010, and an additional cut of 6.5% will follow on January 1, 2011.

Severe instability in the Medicare system is already compromising access to healthcare for America’s seniors. According to a 2010 MedPAC survey, about one in four seniors looking for a new primary care physician had trouble finding one. In addition, the California Health Care Foundation reported that California has one of the worst primary care physician-to-patient ratios in the country.

The threat of cuts to already low Medicare rates has left many physicians uncertain about the future of Medicare in their practice. Although these physicians are dedicated to their Medicare patients, many will be forced to consider changes, including limiting the number of Medicare patients they can accept.

CMA continues to aggressively advocate for a permanent repeal of the Medicare sustainable growth rate. Congress has known for years that the faulty formula Medicare uses to pay doctors does not work, but it has not fixed the problem. We need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.

2. Physicians: Take Action to Stop the Medicare Cuts Today! [top]

You can convince Congress to take action now! There are several ways that you can interact with your representatives to influence them on this issue:

• Set up a face-to-face meeting with your congressional representatives or their staff. You can meet one on one or as a group with other colleagues. Meeting with staff can be just as effective as meeting with elected officials as they have tremendous influence in how elected officials will vote.
• Write a letter, email, or call your members of Congress today. (Click here for a sample letter and talking points.)
• Recruit your colleagues and your patients to contact their members of Congress. (Click here for a sample letter you can give your patients.)
• Write a letter to the editor of The San Diego Union-Tribune about the importance of this issue.

Contacting senators and representatives:

Give your name, specialty, and city/county and urge them to stop the 30% Medicare cuts to ensure patients have access to a doctor.

• Senator Feinstein: Click Here or use AMA’s grassroots hotline at (800) 833-6354.
• Senator Boxer: Click Here or use AMA’s grassroots hotline at (800) 833-6354.
• Representative: Click here or use AMA’s grassroots hotline at (800) 833-6354.

Enter your ZIP code and you will automatically be connected to your representative or senator.

3. Stay Engaged: Become a CMA Legislative Key Contact [top]

Become a part of CMA's Legislative Key Contacts Program to stay engaged on this issue and advocate for your profession.

The Legislative Key Contacts Program is CMA’s premier grassroots advocacy program. The most powerful weapon in advancing the cause of physicians and their patients is you. Hearing from a physician with experience from the frontlines of medicine can make all the difference for a legislator facing a complicated healthcare issue. You don't have to be a political expert or know a legislator directly to serve as a Legislative Key Contact. You just need the desire to make an impact, and CMA will give you the rest. You can sign up by visiting the Legislative Key Contacts page.

4. CMA Comments on Medicare’s Physician Value-based Payment Modifier [top]

The Centers for Medicare and Medicaid Services (CMS) recently solicited input on implementation of the value-based payment modifier to the Medicare physician fee schedule. CMA submitted comments urging CMS to be extremely thoughtful as it implements this program, which was authorized as part of the federal health reform legislation.

The health reform law requires the Department of Health and Human Services (HHS) by 2012 to provide reports that compare patterns of resource use by individual physicians. By 2015, HHS must also apply a new value-based payment modifier to the physician fee schedule. The value modifier is intended to reward physicians who provide more “efficient” care and successfully report on quality measures. Physicians who do not successfully report on quality, and spend more than the national average per Medicare patient, will be paid less than current Medicare rates.

“Although CMA supports efforts to improve the efficiency and the quality of care physicians provide to their patients, we have serious concerns with the program and whether it can be practically implemented,” the comments said.

CMA told CMS that variation in Medicare spending must be adjusted for geographic practice cost differences and the socioeconomic and health status of patients. California has some of the highest rents and wages in the country. CMA believes that lowering payments in high-cost areas without adjusting for practice costs would undermine quality of care and drive more physicians out of these high-cost areas.

California also has an extremely diverse patient population. Numerous studies have found that low-income and ethnically diverse patients have a poorer health status and can be more costly to treat for a variety of reasons. CMA told CMS that changing the Medicare payment formula without a thorough understanding of the socioeconomic factors could harm patients and penalize those who care for the most complex cases. The value modifier needs to specifically adjust for income, insurance status, race, ethnicity, and health status of patients before establishing a physician payment rate.

CMA urged CMS to factor in healthcare spending growth rates. While cities such as San Francisco, Boston, and Manhattan are considered “high-spending areas,” their rates of healthcare cost growth are lower than the lower-spending regions in the rural Midwest.

“If the intent is to slow the rate of healthcare spending increases and reward efficiency, we would urge CMS to consider the healthcare spending growth rates in designing the value modifier,” the comments said.

CMA is concerned that the health reform law presumes the availability of policy tools and a level of precision that do not currently exist. CMA also believes there are fundamental technical problems with the concept of adjusting payments at the individual physician level, as well as with adjusting payments based on outcomes for the previous year’s patient case mix.

5. Key Committee Chairmen Join CMA in Opposing Medicare Geographic Payment Changes [top]

Three key congressmen in charge of committees with great influence over Medicare — U.S. Reps. Henry Waxman, D-Beverly Hills; Pete Stark, D-Fremont; and Frank Pallone, D-New Jersey — have joined CMA in opposing a proposed change in Medicare physician fees that would reduce reimbursements for many of the state’s doctors in 2011. The congressmen sent a letter to the Centers for Medicare and Medicaid Services (CMS) administrator on Sept. 23, 2010. They said it would be premature to make the change before the Institutes of Medicine (IOM) issues a report on the topic next spring.

“Without withdrawal of those changes, physicians and other practitioners could face a rapid sequence of increases and decreases arising from this proposed rule and the implementation of any new proposals arising from the IOM study, as well as the other initiatives under way to improve the payment adjusters,” the congressmen wrote.

The CMS proposal changes the “practice expense” portion of the geographic practice cost index (GPCI). The new rule deweights the impact of rent expenses on physician practices and no longer recognizes local differences in employee wages. The result is that rural areas would end up being paid more than the costs they incur, and urban areas would be paid less than the costs they incur.

Both U.S. senators Barbara Boxer and Dianne Feinstein have also joined CMA in opposing the proposed change. In a letter dated Sept. 22, 2010, Boxer and Feinstein joined 10 other senators in asking the secretary of the U.S. Department of Health and Human Services to hold off on adopting the change in Medicare geographic payments because it “will ultimately undermine patients’ access to care in our states.”

“This is a fundamental shift of more than a billion dollars in Medicare funding away from urban state physicians and patients that will result in even greater financial burden for physicians committed to serving large disproportionately underserved populations,” the letter said.

If the plan recommended by CMS takes effect, physicians in urban and suburban areas could face a 6% payment reduction. This cut would be on top of the 23% SGR cut set to take effect Dec. 1and the 6.5% SGR cut scheduled for Jan. 1, 2011.

CMA is vigorously opposing this arbitrary and politically driven change to the Medicare fee schedule. This is a dramatic change in Medicare payment policy and one that is not supported by CMS’s own data, which shows a wide variation in wages across the country. For example, hourly wages for a security guard in southwest Idaho are $6.68, compared to $24.37 in San Luis Obispo, Calif. — a 264% difference. (Click here to read CMA's letter to Congress on this issue.)

CMA also continues to aggressively advocate for a fix to the long-standing Medicare geographic payment inequities for a number of California counties. Low rates in affected counties have forced many doctors to opt out of Medicare or limit the number of Medicare patients they treat. The net result is that Medicare recipients in these counties have a difficult time finding a doctor.

The Medicare payment formula includes a geographic adjustment factor (GAF) that adjusts the payment rate for local geographic market conditions. The goal is to base physician reimbursement on what it costs to provide care in a particular geographic region. The formula calculates a geographic adjustment factor for every California county, and assigns each county to one of nine of California’s Medicare regions, called payment localities. However, because of rapid growth and development in recent years, physicians in some California counties (El Dorado, Monterey, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Sonoma, and Yolo counties) have practice costs that are up to 10% greater than the average costs of other counties in their Medicare localities.

CMA is urging Congress to place California localities into up-to-date Metropolitan Statistical Areas, which more accurately reflect regional costs, and hold harmless all counties that might experience a payment reduction by such a change. Although the U.S. House of Representatives passed a California geographic payment fix as part of healthcare reform earlier this year, it did not make it into the final bill. Despite support from California’s two U.S. Senators, the issue remains unresolved.