AMA Discusses Medicare Physician Payment Fix

Ruzanna Harutyunyan's picture

The American Medical Association has begun meetings with its member groups to develop a consensus solution to the Medicare physician payment cuts "that send Congress scrambling every year to 18 months to stave them off," CongressDaily reports.

The sustainable growth rate formula, which is used to calculate Medicare reimbursements, has imposed periodic reductions in the payments. However, lawmakers have placed a temporary halt on the cuts each time. According to CongressDaily, AMA hopes to have a proposal ready "before talks on a health care overhaul heat up next year" so that they can "potentially align proposals with key lawmakers" for the 2009 legislative session, CongressDaily reports.


However, an "accord is not as easy as it might sound" because of disagreements between primary care physicians and specialists over payment disparities, CongressDaily reports. The Medicare Payment Advisory Commission has reported that the current payment system tends to favor intense specialty procedures over primary care, which can create a wide income gap between primary care physicians and specialists.

Congressional leaders, including Senate Finance Committee Chair Max Baucus (D-Mont.) and House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.), have suggested that a permanent solution likely will favor primary care physicians. CongressDaily reports that Congress likely will welcome a joint proposal from AMA but that it is too early to predict whether groups representing primary care doctors and specialists can set aside their differences over the payment disparities long enough to reach an agreement on a long-term solution.

AMA plans to discuss the issue next month at its House of Delegates' interim meeting. According to CongressDaily, AMA President Nancy Nielsen in September at a hearing of Stark's subcommittee listed several fixes the association planned to discuss, including bundling payments, quality bonuses and the medical home model. AMA's Council on Medical Service in January plans to present to its House of Delegates a recommendation for fixing the payment system (Edney, CongressDaily, 10/27).

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