AMA delegates rally to knock out cuts in Medicare payments

The House attempted to fix the problem in 2002, but the Senate failed to act.

By Tanya Albert, amednews staff. Jan. 6, 2003.

New Orleans -- Energized by the "Rocky" theme song and impassioned speeches, physicians at the American Medical Association's Interim Meeting in December 2002 vowed to turn up the heat on Congress to stop $11 billion in Medicare payment cuts over the next three years.

Doctors suspended House of Delegates business to rally against physician payment formula problems.

Communicating with Congress
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Waving green signs that said "Stop the cuts," and chanting "Fix the mistake," doctors on the house floor pulled out their cell phones and called their lawmakers to tell them that they need to fix Medicare physician reimbursement when the new Congress convenes this month.

Payment formula problems already caused a 5.4% cut in Medicare physician pay last year. At press time, the Centers for Medicare & Medicaid Services was finalizing a 2003 rule that was expected to decrease reimbursement by another 4.4%.

40% of physicians will not participate in Medicare if pay cuts continue.

If Congress doesn't make changes, physicians would see their Medicare pay drop 18% over four years. That would put 2005 rates below 1991 levels. The cuts also would affect physician reimbursement for treating military retirees and active duty military families who are covered by the TRICARE program, which ties its rates to Medicare.

The reductions would exacerbate a growing access problem for patients, many doctors said. More than 40% of physicians surveyed in an AMA poll said they wouldn't sign Medicare participation agreements if pay cuts continued. The decreases in reimbursement are especially tough at a time when managed care payments are low and medical liability insurance rates are rising.

The Medicare payment issue dominated the meeting.

A time to fight?

"Are you ready to go to battle over the Medicare mistake?" Robert R. McMillan, a lawyer who is the first nonphysician AMA trustee, asked physicians during the rally. Above the podium where he spoke hung a banner that said "Protect America's Seniors: Fix the Medicare Mistake!"

"There is no justification for physician payment to be cut again in 2003," McMillan shouted to the crowd.

Physicians agreed.

"We must make sure America's seniors and patriots don't lose their doctors," said AMA Young Physician Trustee John H. Armstrong, MD, a lieutenant colonel in the U.S. Army Medical Corps.

The rally was the kickoff of what's expected to be a month-long effort to aggressively lobby senators to pass the legislation necessary to correct errors in the payment formula.

At the Interim Meeting, delegates created policy that calls for the AMA to work with state and national medical specialty societies to:

Distribute materials that physicians can display in their offices to let patients know there could be an "access meltdown" if the Senate doesn't fix the formula. The materials urge patients to use the toll-free AMA Grassroots hot line, (800) 833-6354, to call their senators and ask them to prevent the physician pay cuts.
Coordinate a "Washington fly-in" in early January to urge Congress to enact legislation that would stop the cuts. State and county societies also will be encouraged to host similar events at the local level.
Create "mini-internships" that would involve lawmakers and their staff members spending a day in a physician's office so they understand the payment problem.

"We need to express our frustration and anger over the failure of the politicians to act," said AMA President Yank D. Coble Jr., MD. "These cuts make it harder to treat patients."

The AMA also took out a full-page ad in USA Today and The New York Times in December 2002 to alert patients and physicians to the payment problems and what needs to be done to fix them. Ads also will run in other national publications, and the AMA is sponsoring radio spots in key states.

Many physicians at the meeting jumped right into the lobbying effort. Stephen A. Imbeau, MD, a delegate from Florence, S.C., dialed his senator from the house floor with the message that Congress must address the problem in January.

"There are doctors considering making changes in their practice and limiting the number of patients they see," said Dr. Imbeau, who specializes in allergy and immunology. "If nothing is done in January, there will be a feeling of dismay and letdown."

And just in case Congress doesn't act in January, delegates approved a contingency plan to evaluate "aggressive, appropriate" court actions that could correct the problems in the Medicare formula.

"We need to let Congress know what is going to happen if this isn't passed," said Marcy Zwelling-Aamot, MD, an internist and delegate from California. "We need a Plan B."

Lawmakers weigh in

Many members of Congress are aware of the Medicare payment formula problems.

Last June, the U.S. House of Representatives approved a Medicare package that would have increased physician reimbursement by 2% each year for three years, but the Senate didn't pass a similar measure. In November 2002, the House passed a bill that would have protected the Bush administration from lawsuits if it decided to correct the physician payment formula administratively.

But the Senate didn't vote on the measure. Many senators said they would not increase physician reimbursement without raising payments for hospitals, health plans and others.

The House is expected to act again early in its session this year.

"Congress and the White House can no longer tell physicians and the Medicare seniors they serve that we just can't get it done," said House Energy and Commerce Committee Chair Billy Tauzin (R, La.). "We need a law. We need it now."

House Ways and Means Committee Chair Bill Thomas (R, Calif.) said he remained "committed to fixing this problem and reforming Medicare."

Sen. Bill Frist, MD (R, Tenn.), also called for passage of payment formula changes in January. "We must begin taking steps to ensure that today's seniors, and tomorrow's, continue to get the health care they need and deserve," he said.

ADDITIONAL INFORMATION:

Communicating with Congress

The American Medical Association has set up two ways for physicians and their patients to contact lawmakers and the White House about the Medicare payment issue.

Phone: (800) 833-6354, the AMA Grassroots hot line.
E-mail: Go to the Grassroots Action Center Web site (http://capwiz.com/ama/home/), enter your ZIP code under "elected officials" and follow the prompts.
For more information: Visit AMA in Washington page (http://www.ama-assn.org/go/grassroots)