Despite a consensus among lawmakers and the Bush administration that Medicare's physician payment formula needs fixing, the American Medical Association has had trouble getting the issue to the top of the legislative agenda.
Without revisions to the payment formula, Medicare physician rates in 2005 will be on par with those paid in 1991, the AMA said last week as part of a stepped-up effort to lobby Congress for changes. The AMA's self-described "full-court press" may not be enough to spur immediate action, however, as members of Congress are unlikely to address physician payment relief when they're also under pressure to find more funding for hospitals and other providers, lobbyists and Capitol Hill staffers said.
Physicians took a 5.4% Medicare pay cut this year under what is widely considered a flawed payment formula. Unless the formula is recalibrated, physicians' Medicare reimbursement will decline 12% during the next three years, even as their practice expenses rise 40%, AMA President-elect Donald Palmisano, M.D., told reporters last week.
By Nov. 1, when 2003 Medicare rates are expected to be published, physicians will begin deciding whether to accept new Medicare patients, according to Palmisano. Many lobbyists are hoping for a resolution after the November elections, when Congress plans to use a lame duck session to take up issues pushed aside by Iraq, homeland security and other national priorities.
In lieu of a permanent formula change, a temporary fix would help, Palmisano said. A Medicare bill the House passed this summer would give physicians a 2% rate increase in 2003 and later revise the permanent formula. A provider payment bill stalled in the Senate contains similar provisions.
"Physicians want to serve America's seniors. But they simply can't afford to accept an unlimited number of Medicare patients into their practices while facing continued payment cuts," Palmisano said. "Our strategy is to get the message to every lawmaker in Congress."
Lawmakers may have heard the message, but that isn't necessarily enough to guarantee the response the AMA seeks. "There is broad bipartisan agreement that something should be done for doctors, but what exactly is not clear," a Democratic congressional aide said.
Following cuts that took effect in January, at least eight states reported patients had difficulty finding doctors who would accept new Medicare patients, according to an August study by the Medicare Rights Center, a New York-based advocacy group.
The AMA last week cited its own survey of physicians, which indicated that some 42% would not continue to sign Medicare participation agreements if there are additional cuts.
Palmisano suggested revising the physician formula in a "continuing resolution" that is likely to substitute for stalled appropriations bills in Congress.
A lame duck session, meanwhile, "is a horrible bet," said Brent Miller, director of federal government relations at the Marshfield (Wis.) Clinic. Negotiations during these sessions often fall victim to bickering over who is in charge between the election and the next congressional session, Miller said.