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Medicare Physician Payment Action Kit

The failed Medicare physician payment formula known as the Sustainable Growth Rate or SGR must be eliminated now and replaced with policies that promote both better quality and lower costs in Medicare. The AMA has called on Congress again and again to stop the broken cycle of scheduled cuts and short-term patches that impede the development and adoption of new ways to deliver and pay for high quality patient care.

The most fiscally responsible action Congress can take for Medicare is permanently repealing the SGR. This year, the Congressional Budget Office has sharply reduced its cost estimate for preventing SGR pay cuts over the next decade, lowering a major barrier to accomplishing the elimination of this formula once and for all. To put the CBO estimate of $116 billion in perspective, consider that Congress has already spent $153.7 billion on short-term, destabilizing patches to the SGR. It is clear – the time to repeal the SGR and move to a model that works is now.

Permanently repealing the SGR is a vital step to preserve access to care for 49 million seniors with Medicare coverage and 10 million military members and families with TRICARE coverage across the nation. To replace the SGR, an array of Medicare delivery and payment models need to be made available that will give physicians the flexibility to voluntarily choose options appropriate to their specialty, community, practice and patients.

Resources on this page provide background on the Medicare physician payment formula as well as new payment and delivery models, and describe how Medicare pay cuts due to the SGR affect each state.

Be sure to visit FixMedicareNow.org for the latest information and resources on the AMA's campaign to engage physicians, patients and policymakers and transform Medicare into an effective, 21st century model of care. Take action to help repeal the flawed Medicare SGR formula by sending Congress an email or calling their offices through our grassroots hotline at (800) 833-6354. Your patients can help, too! Let's work together to Fix Medicare Now!

How Medicare cuts threaten access to care in your state

Select your state below to see how the looming Medicare cuts will affect access to care. Patients in many areas of the country already face problems getting physician care, and the problems will get worse unless Congress acts quickly to prevent the cuts and works to repeal the broken Medicare physician payment formula.

Alabama Indiana Nebraska South Carolina
Alaska Iowa Nevada South Dakota
Arizona Kansas New Hampshire Tennessee
Arkansas Kentucky New Jersey Texas
California Louisiana New Mexico Utah
Colorado Maine New York Vermont
Connecticut Maryland North Carolina Virginia
Delaware Massachusetts North Dakota Washington
Florida Michigan Ohio Washington, DC
Georgia Minnesota Oklahoma West Virginia
Hawaii Mississippi Oregon Wisconsin
Idaho Missouri Pennsylvania Wyoming
Illinois Montana Rhode Island  

 

AMA recommendations
Medicare physician payment advocacy documents
Testimony and correspondence

AMA letter to entire Senate urging "No" vote on H.R. 4302, March 28, 2014

Sign-on letter to House Leadership and all U.S. Reps. Opposing H.R. 4302, March 26, 2014

Letter to Senate leadership urging bipartisan passage of SGR repeal legislation

Letter to House leadership expressing disappointment that partisanship threatens to derail SGR repeal legislation

Sign-on letter to all Congress supporting H.R.4015/S.2000

Letter from the AMA and 111 state and specialty medical societies sent to House and Senate leadership in opposition to the continued cycle of short-term SGR patches

AMA letter to Rep. Burgess supporting H.R. 4015/S 2000, the "SGR Repeal and Medicare Providor Payment Mondernization Act of 2014"

AMA letter to House Ways & Means on SGR proposal, December 11, 2013

AMA letter to Senate Finance Committee on SGR Proposal, December 10, 2013

Congressional sign-on letter released by Representatives Bill Flores (R-TX) and Dan Maffei (D-NY) urging Congress to repeal the SGR, November 20, 2013

AMA comments on House Ways and Means and Senate Finance Committee's SGR proposal, November 11, 2013

SGR Repeal/Budget Neutrality letter to House Energy and Commerce, July 30, 2013

SGR Budget-Neutrality Markup sign-on letter to House Energy and Commerce, July 25, 2013

AMA comments in response to Energy & Commerce June 28, 2013 draft SGR repeal and replace legislation, July 11, 2013

AMA comments to House Energy and Commerce in response to questions on the Sustainable Growth Rate, June 10, 2013

AMA response to Senate Finance Committee request for input - new Medicare physician payment & delivery reforms, May 31, 2013

AMA comments on E&C and W&M majority "Overview of SGR Repeal and Reform proposal: Second Iteration," April 16, 2013

AMA comments on jointly released E&C and W&M majority “Overview of SGR Repeal and Reform Proposal,” March 4, 2013

AMA Statement for the Record to House Energy and Commerce Subcommittee on Health “SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System,” February 14, 2013

Senate Sequestration sign-on letter, December 21, 2012

House Sequestration sign-on letter, December 21, 2012

AAFP-generated sign-on letter to entire Congress opposing proposal to eliminate the new Medicaid primary care payment increase to fund temporary SGR patch, December 5, 2012

SGR Transition Principles sign-on letter sent to the Chairs and Ranking Members of Senate Finance, House Ways & Means, and House Energy and Commerce Committees, October 15, 2012

Senate SGR Sequestration sign-on letter, September 12, 2012

House SGR Sequestration sign-on letter, September 12, 2012

Comments to Senate Finance Committee Chair and Ranking Member – Medicare Physician Payment Reform Roundtables, August 30, 2012

AMA Statement to Senate Finance Committee re: Medicare Physician Payment Policy: Perspectives from Physicians, July 11, 2012

AMA response to Ways & Means' request for comments on Alternative Medicare Payment Models, May 25, 2012

Letter sent to Rep. Schwartz and Rep. Heck regarding their bipartisan legislation “Medicare Physician Payment Innovation Act of 2012,” May 9, 2012

Sign-on letter to Conferees re: SGR Repeal, January 23, 2012

Letter to Physician Members of the Doctors Caucus urging SGR Repeal, November 17, 2011

Sign-on letter to Deficit Reduction Committee urging repeal of the SGR, November 10, 2011

Beneficiary-Provider letter to Congress, October 20, 2011

Sign-on Letter to MedPAC on SGR, October 3, 2011

W&M Testimony, "Expiring Medicare Provider Payment Policies," September 21, 2011

Sign-on letter to Sen. Murray, Joint Select Committee on Deficit Reduction, September 20, 2011

Sign-on letter to Rep. Hensarling, Joint Select Committee on Deficit Reduction, September 20, 2011

Sign-on letter to President Obama to repeal the Medicare Sustainable Growth Rate, June 27, 2011

E&C Testimony, "The Need to Move Beyond the SGR," May 5, 2011

Letter to E&C Committee re: pathway to reforming the Medicare physician payment system, April 26, 2011

Letter to the Senate urging elimination of the SGR, March 10, 2011

Letter to the House urging elimination of the SGR, March 10, 2011

2013 Medicare sequester update

The 2 percent across-the-board Medicare provider payment cut mandated by the sequester order began on April 1, 2013.  A memo circulated by the Centers for Medicare and Medicaid Services (CMS) on March 8 highlighted a few key points:

  • The 2 percent physician payment cuts applies to all Medicare fee-for-service with dates of service on or after April 1, 2013.
  • The same payment reductions affects other providers with April 1 (or later) dates-of-discharge, dates of service, start date of DME equipment rental, and start date of rental equipment or multi-day supplies.
  • The reduction will be applied to claims payments, after beneficiary coinsurance, deductibles, and any applicable Medicare Secondary Payment adjustments are made.  Allowed charge amounts are not affected.
  • Although beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare payments made to beneficiaries for unassigned claims will be subject to the 2 percent payment cut.

See examples of how the cuts may affect payments.

Additional details on implementation of the sequester will be provided as soon as they are available.