Delegates issue call to action: Time to fix the Medicare mistake

The AMA has launched an action plan to convince Congress to stop the Medicare physician payment cuts.

Editorial. Jan. 13, 2003.

The physicians' signs said it all: "Fix the mistake," "Stop the cuts" and "Seniors deserve better." Doctors are outraged over the U.S. Senate's failure last year to pass legislation to prevent Medicare payment cuts, and it showed in these messages flashed at a physician rally held during the AMA's Interim Meeting in December 2002.

Doctors have good reason for their anger. Last year's 5.4% pay cut has already damaged patients' access to physicians. An AMA survey found that one in four physicians has either limited the number of new Medicare patients they treat or will do so soon.

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This year, reimbursement will be slashed another 4.4.%. All told, doctors are looking at losing $11 billion in Medicare payments nationwide over the next three years. Physician reimbursement in 2005 would slip below 1991 levels. All of these cuts are the result of what is widely acknowledged to be a faulty payment update formula.

Reductions of this magnitude would cause a "Medicare meltdown" in patient access. With each annual cut, more physicians would join the ranks of colleagues forced by basic economics to limit the number of Medicare beneficiaries they serve.

It's not just Medicare patients who would be affected. Because TRICARE rates are tied to Medicare, the families of active duty military and military retirees are also at risk. The Retired Officers Assn. has asked Congress to step in to stop the cuts.

And intervene is exactly what lawmakers must do. Physicians' Medicare payment rates aren't yet set in stone. Congress has some time to review the 2003 payment rule -- 60 days from when the Centers for Medicare & Medicaid Services published it late last year. So lawmakers have a narrow window of opportunity to complete the task they left undone last year and reverse the pay cuts.

To this end, the physician community, led by the AMA, has moved into overdrive with its campaign to convince lawmakers to fix this Medicare problem.

For the first time, the AMA is reaching out not just to physicians, but also to Medicare patients nationwide to enlist them in the fight to prevent the cuts and avoid a worsening of the access problem. The effort will occur in physician practices across the country. The Association will distribute materials for display in doctors' offices explaining the crisis and urging patients to join physicians in contacting their senators using the AMA grassroots hot line, (800) 833-6354.

The AMA House of Delegates approved several other actions aimed at broadcasting doctors' message loud and clear. They include a physician fly-in to Washington, D.C., this month; an advertising campaign with ads in USA Today and the The New York Times and on drive-time radio; and expanded physician grassroots activity through the use of the hot line, e-mail and a widespread fax network.

Several powerful members of the U.S. House of Representatives immediately responded to the AMA delegates' message with statements in support of a payment fix. The list includes House Ways and Means Committee Chair Bill Thomas (R, Calif.), who warned that the successive payment cuts could harm patients' access to care, and House Energy and Commerce Committee Chair Billy Tauzin (R, La.), who called the physician payment formula "fatally flawed."

Indeed, the House did the right thing last year and passed legislation that would have increased physician Medicare pay by 2% each year for three years.

The Bush administration and many senators also agreed that the cuts should not occur.

In the Senate last year, at least 80 lawmakers co-sponsored a bill that would have prevented last year's cut. But that measure and other legislation fixing the Medicare payment problem were stymied by senators who were reluctant to tackle the physician pay issue without also addressing funding increases for others in health care and the call for a Medicare drug benefit.

This year, Congress won't be able to fix all of Medicare's ills in the first weeks of its new session. But the physician payment problem cries out for immediate attention. Doctors nationwide must contact their senators and explain to them the terrible consequences -- both for physicians and the patients they serve -- of another round of payment cuts.

The Senate must join with the House this time and correct what the AMA has aptly termed the "Medicare mistake."