America's high-powered medical profession put on a full-court press in Congress earlier this month, launching one of the most aggressive lobbying efforts in years to try to persuade Congress to rescind a 4.4% cut in Medicare payments set to take effect Jan. 1, 2006.
It didn't work-at least for now.
Led by the Chicago-based American Medical Association, every big doctors' group in the nation blanketed the Beltway with the deadline approaching, warning lawmakers that the cuts would create a potential access crisis for senior citizens by forcing thousands of physicians to limit or exclude new Medicare patients.
"Most medical practices in America are still small businesses," said Duane Cady, a physician who sits on the AMA's 21-person board of trustees and testified in Congress Nov. 17 on the payment issue. "Hopefully we'll get some positive movement on this."
If the current funding formula stands, doctors are slated for total cuts of about 26% from current Medicare payment levels over the next six years. An April poll by the AMA found that about 38% of physicians said they would reduce the number of new Medicare patients they accept once the first round of cuts takes effect in about five weeks.
Every medical association in America seemed to be lobbying Congress earlier this month as time ran short. The AMA, the nation's largest doctors' group with about 245,000 members, was represented by nine of its board members as well as Michael Maves, the group's executive vice president and chief executive officer. Top AMA representatives from 16 state medical associations also were on hand for the final push. Leaders of the American Academy of Family Physicians, American College of Physicians and American Osteopathic Association conducted their own joint "fly-in," visiting more than a dozen congressional offices to press their case.
Still, even the intense lobbying campaign by one of the nation's most influential special-interest groups failed to make much headway among lawmakers preoccupied with issues such as budget deficits, the war in Iraq and the reconstruction of the hurricane-battered Gulf Coast.
In early November, the Senate passed a spending reconciliation bill that provides a 1% increase in doctors' Medicare payments for 2006. Pending legislation in the House would provide a 1.5% hike, but little has been done in that chamber. Now, as 2005 winds down, Congress--which won't put in more than a week or so of work before the new year--may not have the time or the inclination to address the issue or deal with doctors' long-term concerns over the formula used to compute payments.
"The clock is ticking," said Pat Smith, senior vice president of government affairs for the Englewood, Colo.-based Medical Group Management Association, whose members represent medical practices with more than 240,000 physicians. "There is not a lot of time. We are under the gun."
In each of the past two years, doctors received last-minute 1.5% increases in Medicare payments, which represented only about one-half the rate of inflation of medical-practice costs, according to the AMA. Meanwhile, doctors complain that hospitals will be enjoying a 3.1% increase in Medicare payment updates in 2006.
In his testimony before Congress Nov. 17, Cady called the cuts "draconian."
The payment issue is further complicated by the fact that the Senate tied its modest increase to pay-for-performance provisions and has not addressed changes in the so-called "sustainable growth rate," which sets Medicare payments to doctors based in large part on economic growth. Doctors want payments to reflect practice costs. Both the AMA and the MGMA have voiced misgivings about pay-for-performance as it is currently structured.
"What we need first is a stable reimbursement environment," Cady said. "We've asked for positive (payment) updates while we work on the SGR (sustainable growth rate), which has to be replaced. Once that happens, we can go forward and talk about pay-for-performance. The sustainable growth rate and pay-for-performance are incompatible."
For his part, Smith said he is hopeful Congress will somehow find a way to resolve the thorny issue before the clock strikes midnight.
"The most contentious issues in this town are always handled--positively or negatively--at the very last minute," he said. "And this issue is clearly one of the most contentious. We've just got to fight this, every day, until the very end. And that's what we're doing. We're continuing the pressure."