Working today for a hassle-free Medicare tomorrow

AMA Leader Commentary. By D. Ted Lewers, MD. March 5, 2001.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from D. Ted Lewers, MD, chair of the AMA Board of Trustees.

Have you ever discovered that the regulations governing Medicare have changed yet again -- just when you finally figured out how the most recent decree affected your practice? Or have you ever wondered why no one considered the burdensome complexity of a particular regulation -- never mind the cost? Have you ever found yourself raging at the latest Health Care Financing Administration news report -- a report that still does not address your most basic questions?

Or have you simply buried your head in the sand, hoping that the government won't encroach any further on your practice of medicine?

I'll bet you've done all of the above and more, at one time or another. What physician who cares for Medicare patients hasn't?

But the AMA believes we need to do more than rage or despair or deny. We need to act -- and to start getting the many-headed Medicare monster back under control.

The AMA has long recognized that regulatory burdens are a vital issue for physicians. That's why we fought so hard to change how HCFA estimated the sustainable growth rate, and thus how we helped get physician payment updates of 5.4% and 4.5% in 2000 and 2001, respectively. It was physician outrage that prompted us to insist that HCFA bring back its toll-free lines and end the use of proprietary or "black box" coding edits. These were important AMA responses to HCFA's shortsightedness, and we were proud to serve.

Nonetheless, we recognize that regulatory reform does not end with these measures. That's why we're planning to mount an aggressive campaign to change how Medicare regulations are created -- and enforced. In recent weeks, we've been meeting with specialty society representatives and key Congressional staffers to support what's being called the Medicare Education and Regulatory Fairness Act. This proposed legislation would address a number of the most serious problems physicians encounter with Medicare.

First and foremost, the act would make HCFA stop and think, not only about how proposed regulations might affect physicians and patient care but also about how to enforce those regulations.

For example, the bill would prevent Medicare from collecting overpayments from physicians while their appeals are still pending, as well as curtail the use of extrapolations, which significantly -- and often unfairly -- magnify overpayment amounts.

The new legislation would also seek to restructure how HCFA conducts audits and investigations, and stop the criminalization of honest physicians for honest mistakes. The vast majority of us don't try to extort money from the system. Usually, our failure to comply with regulations stems from the bewildering complexity of the system and the difficulty we have making sense of it.

This bill would also legislate that a greater share of Medicare funds be devoted to education about compliance so that we can cut down the number of mistakes and HCFA can stop responding punitively to honest errors -- and instead help us to prevent them from happening in the first place.

We're also supporting measures that would require HCFA to think through new E&M documentation guidelines before implementation, not after. The legislation would require HCFA to complete four pilot E&M programs, at least one of which would reflect a peer-reviewed method.

Finally, the legislation seeks to ensure that the costs of any new regulations are reflected in Medicare payment rates. This means that HCFA would need to consider the cost and burden of regulations before foisting them on us.

Such a provision has the potential to preempt the kinds of problems we are experiencing today, such as the ever-expanding scope -- and cost -- of the Emergency Medical Treatment and Labor Act.

In the coming months, we look forward to working with the new Congress to help shape the new Medicare Education and Regulatory Fairness Act and see it made into law. We trust that President Bush will remember his campaign promise to reduce Medicare hassles. And we are heartened to know that the new HHS Secretary Tommy Thompson has said in his confirmation hearings that relieving regulatory burdens and ending the criminalization of honest physicians would be priority issues during his tenure.

The AMA is also hopeful that, under the new administration, physicians will see positive change at HCFA. In recent months, we have been encouraged by HCFA's efforts to engage physicians in productive dialogue about reform. For example, the AMA has been working with the Physicians Regulatory Issues Team, a physician-dominated group launched by HCFA to assess the Medicare regulatory burden. We are in the midst of proposing reforms to PRIT; for its part, PRIT has promised that we will see concrete and positive change by the end of this year. We are cautiously optimistic that this will indeed be the case.

In the meantime, our message to the 107th Congress, the new administration and Health and Human Services is this:

Don't give us more rules to fill up phonebook-size tomes, or regulations that so confuse us that we risk spending more time with regulatory issues than with our patients.

Physicians need to bring this message to Congress as well. So urge your representatives to support this vital legislation. Call, write or e-mail them through the AMA's Grassroots Action Center Web site (http://congress.nw.dc.us/ama/). Tell them we want patient care, not paperwork.

Let me know what you think. E-mail me.

Dr. Lewers of Easton, Md., a nephrologist and internist, was AMA board chair during 2000-01.