This column was originally published in AMA eVoice on Dec. 20, 2007. Dr. Davis is president of the American Medical Association.
This week, Congress passed legislation that would replace a scheduled 10.1 percent cut in 2008 Medicare physician payments with a 0.5 percent increase through June 30, 2008. The bill, which is expected to be signed into law, also extends expiring rural physician payment provisions and the Medicare physician quality reporting initiative. And it extends the State Children's Health Insurance Program (SCHIP) until March 31, 2009, while providing funding to help states maintain their current enrollment in the program.
The good news is that this legislation will ward off the 10.1 percent cut for 2008 for six months, giving Congress another opportunity to avert a disastrous situation for physicians and their patients. The adoption of a "skinny" Medicare package also jettisoned some negative proposals, such as limitations on physician-owned hospitals and regulation of imaging services. And the extension of SCHIP maintains access to needed health care services for children in low-income families (although the continuing funding level for SCHIP falls short of the level endorsed by the AMA).
The bad news about this bill is that it will mark 6 ½ years that Medicare payments have not covered physician practice costs—a troubling proposition for doctors and seniors alike. It also creates a great deal of uncertainty both for Medicare patients and their physicians, and they deserve better than that. As I mentioned in a recent column in American Medical News, cuts, threatened cuts, and persistent uncertainty about Medicare payments damage physicians' trust in Medicare, and once they leave the program, many may never return.
Why have we seen a failure to solve the Medicare payment problem? The answer is clear to me. The policy-making process in Washington, D.C., is so partisan and political that it has degenerated into dysfunction. The failure to achieve a long-term solution to the problem is not because of a lack of effort by the AMA and its colleagues in state, county, and national medical specialty societies. All of us in organized medicine are disappointed and frustrated that Congress has yet to develop a sustained solution to this debacle, one the AMA has spent substantial resources to bring to the forefront.
This year, the AMA led a $3 million grassroots campaign to avert the 10.1 percent cut in Medicare physician payments, with aggressive lobbying and advertising resulting in more than 50,000 phone calls and 500,000 contacts by physicians and patients to Congress. Thousands of e-mails, letters, and direct-mail brochures were sent, and we purchased huge numbers of TV, print, and Internet ads.
That effort will continue as the AMA works with Congress to resolve the Medicare physician payment problem for not just the final six months of 2008 but into the future. We need a solution that fully funds Medicare payments in a way that covers practice costs, and ensures access to care for the nation's seniors.
In the meantime, many physicians might want to review their Medicare participation options. Any changes in participation status for 2008 must be made by Dec. 31, and the AMA has produced a document (PDF, 56KB) that explains the various options available to physicians. Officials at the Centers for Medicare and Medicaid Services (CMS) stated they would extend the participation deadline for 45 days if Congress passed legislation on Medicare physician payment. The AMA will publicize CMS announcements on this topic once they are made available.
Clearly, there's work to be done, but I ask that you look at the silver lining here: The 10.1 percent cut for 2008 Medicare physician payments has been averted (for now), doctors will see a 0.5 percent increase in payments for six months, and SCHIP funding has been extended until March 31, 2009. Our collective effort positively influenced the outcome, and now we have an opportunity to finish the job. What is needed is relentless advocacy by grassroots physicians and our patients, strong support from organizations that represent seniors, and absolute unity among physician organizations in petitioning Congress for a fair and enduring solution to this problem.
Please send comments, questions, and replies to amaprez@ama-assn.org.
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