AMA, HIMSS call for repeal of current Medicare physician reimbursement law

By Frank Irving
11:02 AM

As physicians face a 24 percent Medicare pay cut come Jan. 1, the American Medical Association (AMA) and Healthcare Information and Management Systems Society (HIMSS) are wielding their influence to spur congressional repeal of the Sustainable Growth Rate (SGR) formula.

The groups join other industry heavyweights — the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP) and the Medical Group Management Association (MGMA) — in calling for elimination of the SGR.

“The AMA has heard the nation’s physicians, and we’re pulling out the stops to get Congress to act and take a fiscally responsible course that will stop the annual cycle of draconian Medicare cuts and short-term patches,” AMA President Ardis Dee Hoven, MD, said in a news release issued during the association's interim meeting this week.

The nation's largest physician group is calling for SGR repeal by year’s end, but also wants Congress to consider a pay-for-performance option along with alternative payment models developed by organized medicine. Among those would be a private contracting option.

HIMSS, meanwhile, noted that the Discussion Draft on SGR Repeal and Medicare Physician Payment Reform, released by House and Senate committees on Oct. 30, contains concepts that depend heavily on "timely adoption and use of health information technology to lower costs and improve quality, safety and outcomes."

HIMSS said it supports — subject to open public discussion on program details — the following goals outlined in the Discussion Draft:

* Developing a solution to address the broken Medicare SGR formula.

* Reforming the Medicare fee-for-service system and encouraging alternative payment models.

* Coordinating current quality incentive programs with value-based payment goals.

* Encouraging care management services for individuals with complex chronic conditions.

* Creating and maturing a value-based, performance driven payment system.

* Expanding the EHR Incentive Program to additional healthcare professionals.

* Harmonizing and expanding quality reporting and measurement systems.

* Incentivizing medical homes and accountable care organizations.

* Recognizing the role of quality and resource-use data in helping consumers make informed purchasing decisions, and helping professionals improve their performance.

* Expanding the use of Medicare data for performance improvement.

On Nov. 13, AAFP President Reid Blackwelder, MD, said his group has offered its support for the bipartisan draft proposal. He added, however, that the 10-year freeze on Medicare physician payments called for in the proposal "would present a significant challenge to family physicians, particularly those in small and individual practices." AAFP recommends that Congress create baseline payments for primary care that are at least 2 percent higher than those used for other services.

ACP President Molly Cooke, MD, said last month that the Senate Finance Committee contacted her group and other physician associations to "seek our ideas on developing an alternative to the SGR that would also create a framework for value-based payment policies."

And in a Sept. 26 letter to Senate leaders [download], MGMA President Susan Turney, MD, stated that the SGR "creates instability in the Medicare program for patients and physicians, and prevents practices from making the significant investments needed to implement and experiment with new value-based payment models. MGMA also cited the Congressional Budget Office in stating that the cost of SGR repeal would be $139 billion, down from an earlier estimate of $244 billion.

This article first appeared in Medical Practice Insider.

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