June 18, 2010
Senate Votes to Push 21 Percent Medicare Physician Pay Cut to Nov. 30
Appears House Will Vote on the New Plan This Week
Last week was a rollercoaster for Medicare physician pay, highlighting the urgent need for permanent repeal of the sustainable growth rate system. Friday the Senate passed legislation that temporarily reverses the 21 percent Medicare physician pay cut in place since June 1 and provides a 2.2 percent update through Nov. 30. However, because of Senate delays, the House had recessed and is not due to return for votes until Tuesday evening.
On Friday, CMS directed contractors to lift the hold on claims for services paid for the first 10 business days of June and begin processing June 1 and later claims under the law's negative update requirement.
What can you do?
- Hold Congressional candidates accountable to this issue
- Continue to let Congress, your patients and your communities know what you think
- Give to OPHTHPAC
Keep the Pressure on Congress for a Permanent Fix
If you have not already done so, ask your employees and patients to join in this effort and sign the Texas Medical Association's online million-signature campaign calling for a permanent solution to Medicare physician pay. A patient flyer (in color or B/W) that includes a brief summary of the issue and the Web link for the petition is also provided.
June 8, 2010
Senate Amendment to Tax Bill May Provide Medicare Physician Pay Stability
Tell Your Senators to Vote for an SGR Solution
Senate leadership today shared with the Academy and others that the Senate will attempt to pass an amendment to the tax "extenders" bill coming up for a vote this week that includes a three-and-a-half-year Medicare physician pay fix. The amendment would reverse the 21 percent sustainable growth rate (SGR) cut that took effect June 1 and improves upon the House-passed 19-month SGR fix. While the Academy deplores the lack of a permanent SGR fix, we also understand the political realities we face and recognize the value of positive, stable updates for your practices in the short term.
Elements of the Senate proposal include:
- 1.3 percent Medicare payment update through Dec. 31, 2010
- 1.0 percent payment update in 2011
- Updates for 2012-13 established under two more-generous formulas:
- E&M and preventive services (GDP plus 2.0 percentage points)
- All other physician services (GDP plus 1.0 percentage point)
- Resumption of SGR formula in 2014 to reflect current law
The 2012-13 expenditure targets are more generous than the current SGR, which is set at GDP with no additional growth allowance. During this two-year period when the actual update is unknown, an update floor is set to ensure no physicians see new conversion-factor cuts under the new formula.
Without a permanent fix to the SGR, however, the current formula would resume in 2014 with a 37 percent cut. The cost of repealing the SGR formula would also be higher than today's $220 billion price tag.
Senate Republicans offered this same amendment a few months ago, when Democrats were considering a five-year fix.
Political Realities
With record national budget deficits, spending money to "fix the docs" is becoming politically more difficult as Election Day approaches (i.e., it may not play well at home with the voters). The Academy supports this improvement over the 19-month fix the House passed. Write your senators and tell them to vote for the three-and-a-half year fix.
If you have questions, contact the Academy's Governmental Affairs Office at 202.737.6662.
June 3, 2010
Congress Due Back Next Week to Try Again on Physician Pay Fix
The 21 percent Medicare fee cut hanging over the heads of physicians since June 1 will be at the top of the agenda when Congress goes back into session next Monday. CMS has told its carriers to hold claims for 10 business days, temporarily forestalling the cut's impact. Still, the fact remains that physicians once again face an unsettled payment situation, due to the inability of Congress to take action on a long-term solution to the sustainable growth rate (SGR) formula.
What awaits the Senate upon its return is a short-term, 19-month fix – passed by the House on May 28 – that provides a 2.2 percent update for the rest of 2010 (retroactive to June 1) and a 1.0 percent update for 2011. The problem gets pushed out to January 2012, when Medicare physician payments would be cut by 33 percent if Congress does nothing.
The Academy and other physician groups continue our aggressive push for full repeal of the SGR pay formula. Today the AMA launched an ad campaign in major national newspapers, highlighting the impact of the Senate's Memorial Day vacation on seniors and military families and pushing for a long-term fix.
Congress must hear our message loud and clear when it returns next week.
How you can help:
- Contact your representative and senators if you have not already done so recently and call for a permanent repeal of the SGR formula
- Contribute to OPHTHPAC, a critical component in the Academy's strategy to permanently repeal the SGR
May 28, 2010
21 Percent Medicare Pay Cut Hits Physicians June 1
Physicians again find themselves on a crash course with the 21 percent Medicare physician pay cut set to take effect June 1. Congress failed to pass the "extenders" bill – including tax measures, unemployment compensation and a sustainable growth rate (SGR) physician fee fix – before leaving town for Memorial Day.
It's another shameful déjà vu, reminiscent of the fiascos physicians encountered at the beginning of April and May when the fee cut technically went into effect. Congress will take up the extenders bill when it returns June 8. Anticipating eventual Congressional action, CMS has instructed its contractors to hold claims for the first 10 business days of June. Under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt, so the hold should have minimum impact on provider cash flow.
Physician groups, including the Academy, will continue their aggressive push for full repeal of the SGR pay formula. We must keep the pressure on Congress! You can help:
- Contact your representative and senators if you have not already done so and call for a permanent repeal of the SGR formula
- Use Academy-prepared talking points to write a letter to the editor of your local newspaper and reach out to your local news radio station(s); contact your local media through the Academy website
- Ask your patients to write to their senators, telling them to permanently fix Medicare physician payment
- Contribute to OPHTHPAC, a critical component in the Academy's strategy to permanently repeal the SGR
Medicare Options
The Academy believes ophthalmologists should know their options. Medicare participation options are listed on the AMA website. While physicians cannot change their participation status until November, they can opt out of the program at any time.
The Academy will provide up-to-date information on Medicare physician payments so that you may make an informed decision about your participation.
In addition, the Academy has joined the Texas Medical Association (TMA), which has launched a million-signature campaign calling for a permanent solution to Medicare physician payment. Members are encouraged to sign the TMA's online petition and encourage patients to also join in this effort. A patient flyer (in color or B/W) that includes a brief summary of the issue and the Web link for the petition is also provided.
If you have questions, contact the Academy's Governmental Affairs Office at 202.737.6662.
May 27, 2010
Threat of Medicare Physician Pay Cut Lingers as Congress Debates 19-Month Fix
House leadership has scrapped the three-and-a-half-year Medicare physician pay fix from consideration in its "extenders" bill due to members' objections to the amount of total spending and unfunded provisions in the legislation. In the latest version of the bill, physicians would get 19 months of positive updates:
- 2.2 percent through 2010
- 1.0 percent through 2011
Medicare physician pay rates would revert to the existing sustainable growth rate (SGR) formula with a cut of more than 30 percent on Jan. 1, 2012, according to the Congressional Budget Office. The cost of repealing the SGR formula at that time would also be substantially higher than today's $220 billion price tag as the cost of a fix continues to grow.
While the Academy believes the House bill is the best offer physicians are going to get for a positive update at this time, we continue to push for a permanent SGR solution. Senate passage of the bill is uncertain, and the Academy joins the AMA in calling on Congress to take action to avert the 21 percent cut scheduled for June 1 before departing for Memorial Day. Anticipating eventual Congressional action, CMS has instructed its contractors to hold claims for the first 10 business days of June. Under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt, so the hold should have minimum impact on provider cash flow.
May 25, 2010
House Bill May Provide Medicare Physician Pay Stability
Fight Continues for Permanent SGR Solution
The House of Representatives is trying to pass an "extenders" bill today that will include a three-and-a-half-year Medicare physician pay fix. Senate action on the bill before Congress' Memorial Day break is doubtful, which means the 21 percent sustainable growth rate (SGR) cut will take effect June 1. However, Congress is expected to act to halt the cut before CMS begins processing claims at the reduced rate, perhaps with another 30-day extension of current physician pay rates. While the Academy continues the push for a permanent repeal of the SGR, we also understand the political realities we face and the need for positive, stable updates for you to operate your practices in the short term.
Elements of the House proposal include:
- 1.3 percent Medicare payment update through Dec. 31, 2010
- 1.0 percent payment update in 2011
- Updates for 2012-13 established under two more-generous formulas:
- E&M and preventive services (GDP plus 2.0 percentage points)
- All other physician services (GDP plus 1.0 percentage point)
- Resumption of SGR formula in 2014 to reflect current law
The 2012-13 expenditure targets are more generous than the current SGR, which is set at GDP with no additional growth allowance. During this two-year period when the actual update is unknown, an update floor will be set at zero to protect physicians from any conversion-factor cuts.
Without a permanent fix to SGR, however, the current formula would resume in 2014 with a cut greater than 30 percent. The cost of repealing the SGR formula would also be higher than today's $220 billion price tag.
Political Realities
We face tough political realities – there are several reasons why Congress won't pass legislation to eliminate the SGR "debt" now:
- With record national budget deficits, spending money to "fix the docs" isn't politically expedient (i.e., it may not play well at home with the voters)
- Politicians' time horizon doesn't (in general) extend very far past the next election
- Fixing the SGR reduces their leverage over physicians
- Partisanship is heightened at this point in an election year
Academy Considers Three-and-a-Half-Year Fix While Pushing for Permanent SGR Solution
While not an acceptable long-term solution, the House bill provides three-and-a-half years of stability with positive updates. Positive updates are critical to continued patient access to physicians. The instability of the recurring 30-day cycle where Congress steps in (later and later) to halt the 21 percent SGR cut, leaving physicians with a 0.0 percent update, must end now!
While we believe the House bill is the best offer physicians are going to get at this time for a positive update, we continue to fight for a permanent fix.
If you have questions, contact the Academy's Governmental Affairs Office at 202.737.6662.
May 20, 2010
Collins/Snowe Key to Medicare Physician Pay Fix
Contact Your Senators and Tell Them the Time is NOW to Halt SGR Cuts
Senators Susan Collins and Olympia Snowe are key to the inclusion of a sustainable growth rate (SGR) fix in the "extenders" bill being negotiated in the Senate. The bill is a vehicle to extend programs that expire May 31, including tax measures, unemployment compensation and the current physician fee fix.
Senators Collins and Snowe need to hear from you TODAY! Their offices say that they're not feeling any pressure from physicians to fix Medicare pay. Attempts in the Senate last year to repeal the sustainable growth rate (SGR) failed to get the 60 votes necessary to pass; despite offsets being offered in the tax bill, Senate passage of a measure is still uncertain. We must keep the pressure on Congress! You can help:
- Contact Senators Collins and Snowe, even if you have already done so, and call for inclusion of an SGR fix in the extenders bill
- Use Academy-prepared talking points to write a letter to the editor of your local newspaper and reach out to your local news radio station(s); contact your local media through the Academy website
If you have questions, contact the Academy's Governmental Affairs Office at 202.737.6662.
May 20, 2010
Alert! Medicare Physician Pay Fix at Stake
Tell Your Senators the Time is NOW to Halt SGR Cuts
Yesterday the Academy participated in a meeting on Capitol Hill – made up of a who's who of House and Senate Democratic leadership and committee staff – to discuss Medicare physician pay fix options. Today Senate leadership is vote-counting to see if there are enough votes to pass the "extenders" bill with a physician pay fix that would halt the June 1 21 percent sustainable growth rate (SGR) cut. One provision being considered would provide reasonable physician updates for the rest of this year and 2011. For 2012 and 2013, rates would continue to increase if spending growth on physician services is within reasonable limits, with an extra allowance for primary and preventive care. Rates could not be reduced in 2012 or 2013, but after that rates would return to their current law levels. The provision is being estimated by the Congressional Budget Office. Leadership is under intense pressure from moderates in both the House and Senate to cut spending; one of the issues being raised is that the SGR fix is $90 billion of the total $200 billion bill.
Leadership mentioned the possibility of a 30- to 60-day fix if there are not enough votes to pass a longer-term fix.
Attempts in the Senate last year to repeal the SGR failed to get the 60 votes necessary to pass; despite offsets being offered in the tax bill, Senate passage of a measure is still uncertain. We must keep the pressure on Congress! You can help:
- Contact your senators and representative, even if you have already done so, and call for a permanent repeal of the SGR formula
- Use Academy-prepared talking points to write a letter to the editor of your local newspaper and reach out to your local news radio station(s); contact your local media through the Academy website
May 13, 2010
Cost to Fix SGR Continues Ominous Increase
Take Our Survey: How Will Options on the Table Impact Your Practice?
As Congress looks at options for a long-term Medicare physician pay fix, the Congressional Budget Office now places the cost of implementing a 10-year freeze in Medicare physician payment rates at $275.8 billion, up from $207 billion late last year. Nine times in the last seven years, physicians have faced Medicare payment cuts that were avoided only after Congress intervened. Physicians now face a 21 percent cut unless lawmakers step in again before May 31.
The Academy is working with the AMA and other state and specialty organizations to determine how to threatened Medicare pay cuts and instability in the program are affecting physician practices. To gather data, we ask that you participate in a short survey that should take only two to three minutes to complete. The survey will be open through the close of business, May 21. Results will be collated for individual specialties and across all specialties.
May 13, 2010
ALERT! Congress Takes First Step Toward Long-Term SGR Solution
House and Senate leaders today discussed plans with the Academy and other medical groups for a longer-term -- but not permanent -- solution to the escalating cuts under the current sustainable growth rate (SGR) formula. Their plan is to include it in the "must pass" tax-extension bill expected to be voted on in the House next week. The statute would provide two years of modest positive updates for the remainder of 2010 and 2011. Beginning in 2012, two new expenditure targets would be created, one for primary care (all E&M) services and then another for all other services, similar to an Academy-supported bill that passed the House last year (H.R. 3961). The Academy will fight to ensure that the new preferential primary care payment targets include the eye visit codes.
Attempts in the Senate last year to repeal the SGR failed to get the two-thirds majority necessary to pass; despite offsets being offered in the tax bill, Senate passage of a measure is still uncertain. We must keep the pressure on Congress! You can help:
- Contact your members of Congress, even if you have already done so, and call for a permanent repeal of the SGR formula
- Use Academy-prepared talking points to write a letter to the editor of your local newspaper and reach out to your local news radio station(s); contact your local media through the Academy website
- Contribute to OPHTHPAC, a critical component in the Academy's strategy to permanently repeal the SGR
April 16, 2010
21 Percent Medicare Physician Pay Cut Reversed, Temporarily
CMS Will Automatically Reprocess Claims Paid at Lower Rate
The week has been a rollercoaster for Medicare physician pay, highlighting the urgent need for permanent repeal of the sustainable growth rate system. President Obama late Thursday signed legislation that temporarily reverses the 21 percent Medicare physician pay cut in place since April 1 until May 31. CMS will automatically reprocess claims filed April 1 to 14 that are being paid at the lower rate.
Keep the Pressure on Congress for a Permanent Fix
The Academy has joined the Texas Medical Association (TMA), which has launched a million-signature campaign calling for a permanent solution to Medicare physician payment. If you have not already done so, you are encouraged to sign the TMA’s online petition and encourage patients to also join in this effort. A patient flyer (in color or B/W) that includes a brief summary of the issue and the Web link for the petition is also provided.
April 15, 2010
Senate Passes Legislation Needed to Halt SGR Cut
Although the 10-business day hold on the 21 percent Medicare physician pay cut technically ends today, the Academy has learned that carriers have not received instructions to implement the cut. The Senate just passed legislation that halts the cut and extends Jan. 1 rates to May 31. The House is expected to act tonight or tomorrow morning on the amended bill and deliver to President Obama for his signature.
CMS may delay processing claims until Monday, but no announcement has been made. The Academy recommends that offices continue to submit claims (either way, we expect CMS to automatically reprocess any claims that were paid with the 21 percent cut).
Senate Democrats were finally able to muster the 60 votes needed to pass the bill. Any fix passed by Congress is expected to retroactively address the Medicare cut. Senate changes required the bill to go back to the House for a vote. Sen. Max Baucus, D-Mont., substituted language into the bill clarifying that physicians who practice in an outpatient/clinic setting are eligible for the $19 billion included in last year’s stimulus bill for adopting electronic health record systems.
April 8, 2010
Physicians Advised to Process Medicare Claims as Normal; CMS Plans to Hold Claims for 10 Days
A 21 percent cut now in effect for physicians under Medicare must be a top priority for Congress when they return Monday night. CMS is advising its Medicare contractors to hold claims for the first 10 business days of April, in anticipation of Congress retroactively addressing the catastrophic Medicare physician pay cut that took effect April 1. Electronic claims are already paid no earlier than 14 days after receipt, so CMS anticipates “minimum impact on provider cash flow.” The Academy advises its members to process claims as normal for the time being. A vote has been scheduled for April 12 when the Senate returns, and Senate leadership is hoping to act on a Medicare physician payment fix.
Physician groups, including the Academy, will continue their aggressive push for full repeal of the SGR pay formula, demanding Congress act next week. We must keep the pressure on Congress! You can help:
In addition, the Academy has joined the Texas Medical Association (TMA), which has launched a million-signature campaign calling for a permanent solution to Medicare physician payment. Members are encouraged to sign the TMA's online petition and encourage patients to also join in this effort. A patient flyer (in color or B/W) that includes a brief summary of the issue and the Web link for the petition is also provided.
March 25, 2010NO FOOLING! Unless Congress Acts, 21 Percent Medicare Pay Cut Hits April 1
Despite aggressively advancing its health care reform legislation this week, Congress failed to make any progress on a long-term fix for Medicare physician pay. At press time, Congress was preparing to extend current rates another 30 days to avoid the 21 percent pay cut looming April 1 as a result of the faulty sustainable growth rate (SGR) formula. While a temporary fix extending current pay rates through Oct. 1 passed in a Senate jobs bill (H.R. 4213) a few weeks ago, that measure remains stalled in the House. Last week the House passed the Continuing Extension Act of 2010 (H.R. 4851), extending current pay rates through April 30. Sen. Charles E. Grassley, R-Iowa, on Tuesday offered a separate extension measure (S. 3153) through April 30.
Physician groups, including the Academy, will continue their aggressive push for full repeal of the SGR pay formula, demanding Congress act when it returns later in April. We must keep the pressure on Congress! You can help:
March 18, 2010
Congress (Again) Extends Short-Term SGR Fix
Not unexpectedly, the House yesterday passed another short-term extension of current Medicare rates for physicians as part of the Continuing Extension Act of 2010 (H.R. 4851), introduced by Ways and Means Committee chairman Sander Levin, D-Mich. The scheduled 21 percent Medicare physician payment cut is now postponed through April 30. If passed by the Senate, this will be the third effort by Congress to provide additional time to develop and pass a long-term solution to the sustainable growth rate (SGR) formula. This move was necessary because the health care reform bill has monopolized floor time, and Congress is scheduled to begin a two-week recess at the end of this month.
Based on a recent Academy member survey to be released next week, a majority of respondents indicated that they would change their Medicare participation status if the SGR cut were implemented. The Academy joined the American College of Surgeons and other medical associations in a letter to CMS asking the agency to extend its March 17 deadline for physicians to change their Medicare participation status. Participation options are listed on the AMA Web site.
March 11, 2010
Senate Passes Short-Term SGR Fix, Which Would Postpone Cuts to Oct. 1
Long-Term Solution Remains ElusiveThe Senate passed a jobs bill (H.R. 4213) that includes an extension of Medicare physician payment rates until Oct. 1. The Academy believes this is Democratic leadership’s attempt to keep medicine at the table on health care reform. House consideration of H.R. 4213 may be delayed, however, due to action related to health care reform; this would necessitate another 30-day extension to keep physicians from experiencing the 21 percent sustainable growth rate (SGR) cut on April 1 (since Congress will be out for a two-week recess). The Academy has joined the AMA in expressing opposition to continued short-term fixes as destabilizing the Medicare program for physicians and their patients. We have stepped up efforts to make clear that short-term patches are fiscally irresponsible because they increase the size of the physician pay cuts and the cost of a permanent solution.
At a conference attended by Academy staff, Sen. Tom Harkin, D-Iowa, signaled that a long-term SGR fix for physicians could be a few years off. Harkin, pointing to how things have changed, said “with the deficit as high as it is, it’s hard to see Congress moving to apply all that money to fix the problem [this year].”
March 4, 2010
Academy Escalates Fight for Permanent Medicare Pay Fix on Heels of Yet Another Short-Term Extension
The House and Senate now are discussing the next steps to address the Medicare physician payment crisis, after President Obama signed into law the Temporary Extension Act of 2010 earlier this week. The act provides another short-term sustainable growth rate (SGR) fix, halting the 21 percent Medicare physician pay cut imposed on all physicians March 1. Claims dated March 1 and later that were held by Medicare contractors will now be released for processing.
While short-term fix proposals (90 days, seven months or through the end of 2010) are being circulated, Congress continues to falter in tackling a long-term solution. Your help is critical in the Academy’s fight to permanently repeal the SGR and replace it with a fair reimbursement formula. We must keep the pressure on Congress! You can help by:
