Special SDCMS "News You Can Use" — The SGR Non-fix (2010.06.01)

Special SDCMS "News You Can Use" — The SGR Non-fix
— June 1, 2010

Overview of Congressional (in)Action on SGR [the (un)Sustainable (non)Growth Rate, i.e., the Cost-of-Living Adjustment for All Medicare Part B Rates]

1. The House passed an SGR "band aid" - see below for specifics- but the Senate adjourned prior to addressing the House bill, thereby allowing the 21%, across-the-board cut on Medicare rates to go into effect today, Tuesday, June 1, 2010.
2. The House bill, an amended version of HR 4213, the "American Jobs and Closing Tax Loopholes Act of 2010," would stop Medicare SGR cuts for 19 months. In lieu of the 21% cut originally scheduled for 2010, the House-passed proposal would implement a 2.2% payment update for the remainder of 2010, and a 1% payment update for 2011. Because this is just another short-term fix, not a permanent repeal of the SGR, physicians will end up facing another significant cut in 2012 of 33%.
3. Congress will reconvene no earlier than June 7, 2010, so no action on the SGR will occur prior to Monday next.
4. This is the third time this year that Congress has allowed Medicare cuts to go into effect. Twice this year, they've restored the cuts by simply moving the cut implementation deadline for the programmed cut by several months. Congress has systemically failed to address the SGR. In the vernacular, Congress is kicking the can down the road - failing to address a real fix for this broken formula - despite repeated public promises to do so. And each delay raises the ultimate price of resolution.
5. The Center for Medicare and Medicaid (CMS) implemented a 10-business-day hold on all Medicare payments. This prevents, assuming congressional action in less than 10 working days, the cuts from actually appearing in physician Medicare checks. However, this also imposes a 10-day minimum delay in Medicare cash flows.

What Can You Do?

1. Contact the offices of Senators Boxer and Feinstein to thank them for their support of physicians and to ask them to continue their support for a systematic solution to the SGR, for stopping the 21% cut, and for fixing the GPCI inequity. Use the toll-free AMA hotline to contact Senators Feinstein and Boxer [(800) 833-6354] - it took me 15 seconds for the appropriate phone to start ringing.
2. E-sign the SGR petition asking for a permanent relief from this legislative lunacy.

Media Action to Date:

1. Click here to access the KPBS piece by the SDCMS communication chair on this matter.
2. Click here to read the the CMA president's statement.
3. Click here to read the AMA president's statement.

The Silver Linings (Yes, There Are Actually Two!!!)
There are actually two pieces of good news on the Geographic Practice Cost Index (GPCI) inequity - where San Diego (and several other large urban counties in California) are paid artificially (and incorrectly) lower Medicare rates because these urban counties are inappropriately lumped in with lower-cost rural counties to create average rates that punish the urban counties and artificially raise Medicare rates for the rural counties. There are potential retrospective and prospective fixes in the winds!

1. The House bill includes a five-year GPCI pilot for San Diego and up to 14 other California counties to align Medicare reimbursements with actual cost, while holding other California counties (such as Imperial County) harmless. If approved by the Senate, the fix goes into effect January 1, 2012. Based on today's assumptions, Medicare rates would be raised across the board by between 4% and 5%, and many expect the actual increase to be higher (between 5% and 6%) based on new data being calculated. This was the result of intense and effective lobbying by CMA and your local San Diego County Medical Society physician advocates - member physicians' dues dollars at work.
2. Second, the federal lawsuit spearheaded by San Diego and Santa Cruz counties, suing CMS for retrospective damages to the tune of over $2 billion, was remanded for mediation by the appellate court. This is a potentially huge victory because the trial judge had dismissed all but one count of the lawsuit because of technical issues. The appeals court, however, has not reached that conclusion and has directed that parties mediate rather than dismiss the lawsuit. The potential payout for San Diego for retrospective underpayment was originally over $180 million, and may go higher. A little math here: $180 million divided by roughly 6,700 San Diego physicians = a lot of money for San Diego's docs - we're not there yet, but this will be the result of members' dues dollars at work!

Thank You's
Finally, please take the time to thank our three congresspeople who voted to support physicians and who voted "aye" on HR 4213: Representatives Davis, Filner, and Bilbray. Of special note, Congressman Bilbray was one of only 15 Republicans who voted to support San Diego's physicians. Again, these votes are the results of tireless SDCMS advocacy and relationship building over literally decades to make sure the physician point of view is understood.

Additional News ...

FTC Again Extends Enforcement Deadline for Identity Theft Red Flags Rule
As a result of requests by several Members of Congress, the Federal Trade Commission (FTC) is once again delaying enforcement of the "Red Flags" Rule until January 1, 2011. As part of the FTC's implementation of the Fair and Accurate Credit Transactions (FACT) Act of 2003, most medical providers would have needed to comply with the "Red Flags" rule by June 1, 2010. The rule requires "creditors" - which the FTC defines to include most healthcare providers - to establish a program to prevent identity theft in their practices. Click here for further information.