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3 Groups Payers Will Watch Closely in 2013

Jacqueline Fellows, for HealthLeaders Media, January 2, 2013

Several groups rushed to issue statements on the so-called "doc fix". President and CEO of the American Hospital Association (AHA), Rich Umbdenstock issued a statement saying, "While fixing the physician payment formula is essential, it should not be done by jeopardizing hospitals' ability to care for seniors and their communities. That's why we are very disappointed at the approach taken in this measure. Hospitals are working to provide high-quality, innovative and effective care to seniors in their communities. Additional payment reductions will make it harder for patients to access the care they need and depend on."

MGMA-ACMPE (formerly MGMA) President and CEO Susan Turney, MD, issued a similar statement on the last-minute agreement.  "Although Congress again averted another massive Medicare physician payment cut at the 11th hour, this action only perpetuates another year of uncertainty for physician practices forced to continue their work under the dark cloud of looming SGR cuts and the new threat of sequestration cuts scheduled for March."

"Without action to permanently repeal the sustainable growth rate formula, Congress will replay this fiscally irresponsible scenario again and again, with even larger cuts awaiting practices in the near future. Physician practices need a stable, predictable Medicare payment system to allow them to make sound, long-term decisions to invest in their practices, position themselves for the future, and provide the highest quality care to the Medicare patients they serve."

Congress also still has to deal with the sequestration cuts (postponed by only two months) to Medicare, which reduces the program by $11 billion over the next decade. Why is this important to payers? Health insurance companies use Medicare as a benchmark for their own reimbursement rates.

Another reason payers will be watching Congress in 2013 is to see if it repeals the health insurance premium tax levied against payers to help pay for healthcare reform. America's Health Insurance Plans  points to studies showing the tax, which begins in 2014, will increase premiums. A bill in the U.S. House with 200 co-sponsors went nowhere in 2012, but with a new Congress and the sequestration cuts still in play, it could be a bargaining chip.

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