AADA urges Congress to protect Medicare physician payment

Widespread bipartisan support for repeal of Medicare payment formula in this year

After years of riding the roller coaster of Medicare’s Sustainable Growth Rate (SGR) formula, many in Congress signaled support for action to address the formula before adjourning for the year. AADA is pleased to see an uptick in congressional interest to end the broken payment formula, and plans to use the remaining days of 2014, to advocate for further movement on a permanent solution for fair and stable reimbursement. Since Medicare payments were cut in 2002, Congress has acted on 17 times to stop payment cuts that would have otherwise been required by the SGR.

In a letter to House Republican leadership the GOP Doctors Caucus called for passage of the SGR Repeal and Medicare Provider Payment Modernization Act. Echoing further action to fix the SGR permanently, a group of 114 members of Congress, from both sides of the aisle, implored Speaker John Boehner (R-Oh.) and Minority Leader Nancy Pelosi (D-Calif.) to act, citing the almost record low projected cost to repeal it. All AADA members are urged to contact their Senators and Representatives to take action to reform Medicare’s broken payment system and repeal the SGR formula this year.

AADA supports legislation to provide flexibility in HIT reporting

This week, the AADA sent a letter of support for H.R. 5481, the Flexibility in Health IT Reporting (Flex-IT) Act to Rep. Renee Elmers (R-NC) and Rep. Jim Matheson (D-UT) who introduced the legislation that would allow for a 90-day reporting period for demonstrating Meaningful Use (MU) through 2015 for the Centers for Medicare & Medicaid Services’ (CMS’) Electronic Health Record (EHR) Incentive Program. The AADA’s letter noted that requiring one full year of reporting in 2015 would impose a significant burden particularly on small and solo practices, many of whom have been unable to implement the new technology. Moreover, these providers will be subject to downward Medicare payment adjustments in 2017.

AADA urges CMS to extend deadline in final rule for EHR attestation

While the AADA applauded the Centers for Medicare & Medicaid Services (CMS) for reopening the submission period for hardship exception applications for eligible professionals (EPs) for its Electronic Health Record (EHR) Incentive Program, it noted in a letter to the CMS Administrator Marilyn Tavenner that providers could not comply with deadlines set in the final rule published on September 4, 2014 because the CMS computer system was down for updates, leaving some EPs who acted in good faith to meet the CMS deadlines still facing a penalty in 2015. The CMS registration and attestation website did not permit new EPs to attest to the 2013 edition of Stage 1 leading up to the October 1 deadline. Given that the CMS website will not be upgraded until mid-October to allow EPs to attest, the AADA called on the CMS to retroactively extend the October 1 attestation deadline. In addition, the AADA urged the CMS to shorten the 2015 EHR reporting period from 365 days to 90 days.

Call on Congress to support SGR repeal this year

AADA members are urged to contact their representatives in Congress and ask them to add their support to a letter being circulated by Representatives Kurt Schrader (D-Oregon) and Reid Ribble (R-Wisconsin). The letter calls on leadership in the House of Representatives to take action this year to reform Medicare’s payment system and repeal Medicare’s broken sustainable growth rate (SGR) formula. In addition to the AADA, the American Medical Association and other physician organizations support the letter. Representatives Schrader and Ribble plan to send the letter to House leadership in November.

Take Action: Ask your representative to sign on to the Schrader-Ribble letter.

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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