Major Issues Affecting Physicians

There are several important issues being debated on Capitol Hill.  Let your voice be heard.   AMA and CMA also urge all physicians to call their representatives and to get involved.  Among all the issues being debated there are four major issues that will affect physicians’ reimbursement.  We have listed four major action plans and briefly explained each item below:

Four Major Action Plans:

  1. Repeal the Medicare SGR.
  2. Stop the IMAC – Independent Medicare Commission. Return it to Congress.
  3. Oppose the Value Index and the Feedback Program.  They impose arbitrary payment reductions and should be tested under pilot programs.
  4. Increase Medicaid rates to ensure access to physicians.

Brief Explanation of the Four Major Issues:

  1. SGR: The Senate Finance Committee bill does not reform the Medicare Sustainable Growth Rate (SGR) formula.  It stops the SGR cut in 2010 but imposes a 21.2% cut in 2011 with additional cuts in later years. Physician rates lag at least 20% behind their practice costs.  It is time to repeal the SGR once and for all.  Otherwise, Medicare seniors will have an increasingly hard time finding a doctor.
  2. IMAC: The Senate Finance Committee bill establishes an Independent Medicare Commission (IMAC) to adopt policies to rein in Medicare spending.  They are mandated to find $22 billion in savings over 10 years if spending exceeds the CPI.  Congress is the accountable body that should be making important decisions impacting patient access to care.  Physicians face two sets of cuts from both the SGR and the IMAC.  It’s double jeopardy.
  3. Physician Outlier Feedback Program AND the Value Index: The healthcare bill establishes two similar programs that could impose Medicare payment cuts on California physicians.  The Feedback program would reduce payment by 5% for physicians who are “outliers” – utilization is above the 90th percentile of national utilization rates. This could penalize physicians who treat the sickest patients because current risk adjustment methods are not adequate. The Value Index program would reduce payment to physicians in high spending regions.  California has high spending regions in part because we have high practice costs (rents and staff wages) and higher numbers of uninsured, poor, minority patients who have not had good access to medical care and therefore, their conditions are more costly once they reach Medicare age. Both the Physician Outlier Feedback and Value Index programs would depend on claims data that is extremely limited. 
  4. Medicaid Reform:  The Senate bills include major expansions of the Medicaid program to cover low-income families.  Yet families on Medi-Cal in California are already experiencing serious problems finding a doctor because the payment rates are 60% below Medicare rates.  New families signing up for Medicaid will not find a doctor.  31% of CA ER visits are from Medi-Cal patients vs. 18% for the uninsured.  Congress will exacerbate the access problems if they don’t finance increased Medicaid rates. 

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