SFMS Urges Representatives Pelosi and Speier to Support Repeal of SGR

SFMS, together with the Hospital Council of Northern and Central California, sent the following letter to Representative Nancy Pelosi to urge her to support the repeal of Medicare SGR formula. The same letter was also sent to Representative Jackie Speier.

Click here to view a pdf copy of the letter.

 

 

 

 

Dear Leader Pelosi,

 

Physicians and hospitals in San Francisco are joined in our concern about the proposed 27 percent cuts in Medicare payments to physicians. The impact on your constituents would be profound—increasing numbers of the elderly will lose access to primary care, and instead seek such care in the emergency room—care that costs more and is inappropriate to their needs.

We understand that unspent military funds could be used to repeal the Medicare SGR formula.  The cuts have been delayed until March 1 in the hopes that some kind of compromise can be found. One possibility is a plan recently suggested to use unspent military funding from early troop withdrawals in Iraq and Afghanistan to repeal the Medicare Sustained Growth Rate (SGR) payment formula.

That idea and others will be considered by a House-Senate conference committee that includes Rep. Henry Waxman (D-Los Angeles) and Rep. Xavier Becerra (D-Los Angeles). The California Medical Association, the California Hospital Association, the American Medical Association and American Hospital Association as well as many other medical associations have united to push for the House Democrats’ plan, which could cover the $300 billion cost of eliminating the SGR formula. The AARP has joined as well, launching a campaign with the message, “Medicare patients could lose access to the doctors they know and trust in just a few weeks.”

We urge your support for this compromise measure to be debated soon. Your constituents will certainly benefit.

Senators Boxer and Feinstein Pledge to Repeal Medicare SGR

Senator Boxer, a long-time supporter of repealing Medicare SGR, has sent a letter in response to the SFMS letter to local legislators urging them to advocate for the repeal of SGR.

Click here to view the letter from Senator Boxer.

Click here to view the letter from Senator Feinstein.

Click here to view the original SGR letter from SFMS.

Dear Dr. Curran:

Thank you for writing to me about the need to fix the Medicare Physician Payment Formula. I appreciate hearing from you, and I share your desire for a permanent solution to this problem.

Without congressional action, an over 27 percent reduction to physician reimbursement under Medicare will take effect on March 1, 2012.

I have supported legislation to repeal the flawed Sustainable Growth Rate formula and replace it with a more stable system that ends the cycle of looming fee cuts followed by short-term patches and budget gimmicks. I believe that such a reform is critical for physicians, seniors and military families covered by TRICARE.

Be assured that I will keep working with my colleagues to enact legislation to reform the Medicare physician payment system.

Again, thank you for writing to me. Please feel free to contact me again about this or any other issue of concern to you and the San Francisco Medical Society.

Save the Date: 4/17 Legislative Leadership Conference/Lobby Day

Join SFMS for the CMA Legislative Leadership Conference on April 17 in Sacramento. We’re excited to announce California Attorney General Kamala Harris and Governor Jerry Brown as special guest speakers.

SFMS members have the unique opportunity to gain advocacy training and network with colleagues throughout California at this annual event. Legislative Day is offered at no cost to SFMS members. Please email SFMS at info@sfms.org or call (415) 561-0850 if you would like to attend this event.

The morning includes speeches from a number of key legislative leaders. Attendees will go to the Capitol in the afternoon to meet with legislators on health care issues. The meetings will be scheduled and coordinated by local county medical societies.

Medical students and residents

Funding may be available to offset travel expenses to participate in the event. We will be organizing a vanpool for participants. Please contact SFMS for more information.

Hotel Details

Sheraton Grand Sacramento is extending a discounted rate of $159 for conference participants. Online reservation instructions are available here. Reservations can also be made by calling (800) 325-3535 or (916) 447-1700 – ask for the California Medical Association corporate rate.

Medicare SGR Faces A Bitter End As Senate, House Remain At Odds Over ‘Doc Fix’ Dilemma

The 2011 Congressional legislative session comes to a bitter end today. Members of Congress will go home for the holidays in a rare standoff that will not result in a last-minute agreement to stop the Medicare SGR 27.4% fee-for-service program payment cut, or extend the payroll tax cut and unemployment benefits.

SFMS/CMA is absolutely outraged that Congress will adjourn and let this devastating nearly 30% payment cut take effect.  For a decade, CMA and organized medicine has been calling upon Congress to eliminate the Medicare SGR. All year, Members of Congress made commitments to CMA physicians and seniors that they would stop the cuts and adopt a long-term solution to the failed Medicare SGR physician payment formula. In the height of irresponsibility, Congress will go home for the holidays and deal a terrible blow to physician practices and their patients. Most physicians will not be able to sustain such a cut and remain in the Medicare program. Others could be forced to close their doors. Seniors in California are already experiencing difficulty finding physicians. This will have a devastating impact on access to physicians for California’s 5 million seniors and nearly 1 million military families.

Late last week, when negotiations failed between the House and the Senate, a bipartisan group of Republican and Democratic Senators crafted a short term two-month extension on the Medicare SGR, payroll tax cut, and unemployment issues to avoid the devastating cuts that will occur next week. The Senate passed the measure with overwhelming support 89-11. However, under the direction of Speaker Boehner, the House leadership rejected the 2 month extension and are holding out for a longer term deal. The standoff will remain unresolved until Congress returns in January 2012.

SFMS/CMA has been advocating for legislation that eliminates the SGR and adopts a longer-term path to an alternative payment system. Within the last few days, to avoid the inevitable, CMA supported the 2-month stop-gap on the Medicare SGR to avoid devastating cuts and a retroactive payment restoration.

Unfortunately, the Medicare SGR was tied to much larger controversial issues in the year-end legislative package. While no formal statements have been made by either the Senate or House leadership about their intent to return in January to stop the cuts, we expect Congress to return on January 3 rather than January 17 to address these issues. The House has created a conference committee to bargain over the differing House and Senate bills.

The Centers for Medicare and Medicaid Services (CMS) announced that they would hold claims starting January 1 through January 17 to avoid paying physicians at the lower rate and to avoid a retroactive reconciliation of claims in the event Congress acts in early January to stop the cut. CMS said they will be forced to process claims at the lower rate starting January 18 if Congress does not stop the cut. 

SFMS/CMA will keep you informed as the debate continues. We have expressed our anger to our Congressional delegation for failing to keep their obligation to appropriately finance the Medicare program and to protect access to care.

Medicare SGR Patch Tied to Controversial Social Security Payroll Tax Cut Bill

Congress continues to work to form an agreement on stopping the 27.4% Medicare sustainable growth rate (SGR) fee-for-service program cuts before they take effect on January 1, 2012. Both the Republican and Democratic leaders in the House and the Senate have publicly said they are dedicated to stopping the Medicare fee-for-service payment cuts before the end of session. It is one of their top priorities and will be included in a large legislative package to extend the Social Security payroll tax cut and unemployment insurance benefits.

House Legislation

A blog post from Boehner's office says everything in the bill is paid for through spending cuts rather than tax increases. Photo credit: AP

The House Republican leaders unveiled the House legislation on December 9. Among many other things, it would stop the Medicare SGR fee-for-service payment cuts for two years and provide a 1% update in both 2012 and 2013. It also requires the Medicare Payment Advisory Commission (MedPAC), Government Accountability Office, and U.S. Department of Health and Human Services to make recommendations to Congress on long-term alternatives to the Medicare SGR physician payment system. There is also a relaxation of the restrictions on existing physician-owned hospitals. The legislation will be voted on in the House tomorrow, December 13.

Proposed funding sources

The bill provides funding sources from the Patient Protection and Affordable Care Act (ACA) including cuts to government subsidies to buy health insurance for individuals whose income level increases during the same fiscal year, as well as cuts to the ACA public health and prevention fund, which SFMS/CMA are strenuously opposing. The proposal would also raise Medicare premiums on individuals making more than $1 million. It reduces Medicare payments for E&M services provided in hospital outpatient settings to the same level those services are reimbursed in physician offices. And, it reduces payments to Disproportionate Share Hospitals, which the hospitals strongly oppose.

Timing and process

At this point, the Medicare SGR is being solely negotiated out of House Speaker John Boehner’s office with the Senate leaders and President Obama, and is tied to the outcome of the Social Security payroll tax cut deal. Voting on this legislation could come as early as December 13. Most expect it to pass the House; however, the bill faces stiff opposition from both Republicans and Democrats in the Senate. The opposition to the proposal is related to some of the funding sources, the limited extension of unemployment benefits, the changes in funding for the Social Security Trust Fund, and the inclusion of the controversial Keystone XL oil/gas pipeline across the Midwest. Senators are not, however, opposed to the Medicare SGR provision.

Negotiations continue this week

The Senate is expected to vote down the House Republican plan on Thursday, which will spur another round of negotiations. Congress is set to adjourn on Friday, December 16, but the leadership has said they will hold session through the following week until they reach an agreement.

SFMS/CMA are working to obtain assurances from the California House Republican leaders and Senate offices that if the payroll tax deal goes down, they will still address the SGR cuts in separate legislation before they go home for the holidays. If the negotiations totally blow up, the Senate may try to run a Continuing Resolution (CR), which will include a stop-gap on the Medicare SGR cut.

However, as controversial funding sources are negotiated out of the bill, that could reduce the length of the SGR stop gap from two years to one year, or change the payment increase. Moreover, there is a chance the rancor could stall all legislation, which means physicians could be hit with a 27.4 percent cut until Congress returns in January.

As the Congressional bargaining continues, California physicians should know that Congressional leaders are working as quickly as possible to stop the Medicare SGR fee-for-service payment cut. However, politics over the larger issues is hindering a resolution to the Medicare SGR cut.

SFMS/CMA will remain vigilant in keeping the pressure on our Congressional delegation and leaders to ensure the Medicare SGR cut is stopped as soon as possible – and for as long as possible. We have told Congress that these cuts will have a drastically negative impact on physicians and their patients, and that they cannot go home without stopping them. We have also been clear that a retroactive stoppage in January would be disastrous. Physicians should not be forced to finance the Medicare program on their backs because of Congress’s irresponsibility.

Please help to keep the pressure on Congress to stop the Medicare fee-for-service SGR payment cut! Contact your legislator today!

Please use the AMA hotline at (800) 833-6354. Enter your ZIP code and it will automatically connect you to your Representative. Please call the hotline again to reach Senators Boxer and Feinstein. You can also send emails via https://writerep.house.gov, www.boxer.senate.gov and www.feinstein.senate.gov. The sheer volume of calls is important so Congress knows you are watching closely and they must act.

Tell your Representatives and Senators Boxer and Feinstein that:

1. The Medicare SGR cut must be stopped before the end of the year.
2. The cuts will harm access to care for 5 million California seniors.
3. The cuts will wreak havoc on physician practices.
4. Congress should not go home and think it’s OK to stop the cut retroactively in January.
5. Physicians should not be forced to finance the Medicare program because of Congress’s irresponsibility.

Click here for more coverage on the SGR bandage.