AADA urges Congress to protect Medicare physician payment

AADA urges Congress to protect Medicare physician payment

Congress passes, Pres. Obama signs 12-month patch; halts progress on SGR repeal

Congress has passed, and President Obama has signed, the Protecting Access to Medicare Act (HR 4302) which includes a one-year patch which avoids a 24 percent Medicare physician payment cut that was scheduled to begin April 1, 2014; delays the implementation of ICD-10 until October 2015, and consequently stalls progress on the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, HR 4015/S 2000.  

Prior to the House's consideration of HR 4302, the AADA joined the American Medical Association and other specialty organizations opposing this legislation. This is the 17th “patch” that Congress has enacted on SGR since 2002. Although the reprieve from ICD-10 is helpful, the AADA is concerned because this legislation also includes a troublesome provision to pay for the reprieve by expanding the list of criteria used to identify potentially misvalued services. Read the letter of opposition.

While the AADA is disappointed that Congress did not take this opportunity to finalize a permanent solution to Medicare payment reform, the AADA remains steadfast and calls on Congress to enact full-scale reform, and build on the bipartisan, bicameral effort that produced HR 4015/S 2000.

Medicare payment reform proposal

Medicare physician payments would increase by 0.5 percent each year for five years under a new agreement on Medicare physician payment reform which would repeal the sustainable growth rate formula. The proposal still needs to be approved by both chambers and Congress will have to address the issue of how to pay for reform.

Read more about the payment reform proposal.

AADA advocacy

HR 4015/S 2000 progress

The U.S. House of Representatives passed the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, HR 4015. A provision was added that offsets the cost of the bill by delaying the Affordable Care Act (ACA) mandate that requires individuals to have health insurance. Senate Finance Ranking Member Orrin Hatch (R-Utah) followed by introducing S 2122, which would also offset the cost of SGR repeal with repeal of the individual mandate.The Senate majority did not accept this provision to pay for SGR repeal.

Senate Finance Committee Chairman Ron Wyden (D-Ore.) introduced the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 (S 2110), which includes the bipartisan reform provisions of S 2000 along with additional Medicare and Medicaid provisions, but does not include provisions offsetting the cost of reform. While Senate Majority Leader Harry Reid (D-Nev.) filed S 2110 for possible action, the legislation did not receive the support needed to clear the Senate. In addition, because of the lack of fiscal offsets in S 2110 the House could not accept this bill.

AADA responds to congressional inquiries about Medicare physician payment reform

The AADA responded to several congressional inquiries about how to repeal and reform the flawed Medicare physician payment system:

AADA supports bill strengthening Medicare patients’ access to care

In April 2013, the AADA signed on to a coalition letter supporting legislation that would allow Medicare patients to access the physicians of their choice, even if the physicians are no longer accepting Medicare. Introduced by Rep. Tom Price, MD, (R-Ga.), HR 1310, the Medicare Patient Empowerment Act, would ensure that Medicare beneficiaries and physicians are able to freely contract for covered Medicare services without penalty, while providing important beneficiary protections.

Under the current law, Medicare beneficiaries who choose to see physicians who do not accept Medicare are required to pay the physicians' charges entirely out of pocket because Medicare does not pay any part of the charges. 

In addition, physicians who choose to provide covered services to Medicare beneficiaries under private contracts must "opt out" of the Medicare program for two years, during which time Medicare does not pay the physicians for any covered services provided to Medicare beneficiaries.

If enacted, HR 1310 would significantly strengthen Medicare patients’ access to care. Read the AADA's letter of support

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