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Physicians Forecast Hot Winter on Capitol Hill

 |  By jcantlupe@healthleadersmedia.com  
   August 11, 2011

Record-breaking heat has baked parts of the nation this summer, but come winter, legislative corridors will still be sizzling. This time the heat will come from intense lobbying over how physicians are paid.

Things got underway in May when The American College of Emergency Physicians visited Congress to "enlighten" lawmakers about healthcare issues, says ACEP President Sandra M. Schneider, MD, FACEP.

The ACEP contingent called on more than half the 435 House of Representative offices and 94 of the Senate's 100 offices. They discussed everything from healthcare reform to the Sustainable Growth Rate.

The meetings were held before the contentious debt ceiling vote in July, in which Congress agreed to raise the country’s legal limit on borrowing. Earlier, this month, President Obama signed the measure, making a $2.4 trillion downpayment on the federal deficit over the next decade.

For physicians, the debt ceiling debacle may have felt like the roof caving in. "I think the debt ceiling showed how dysfunctional Washington is, on both sides of the aisle," said Schneider, an attending physician at Strong Memorial Hospital in Rochester, NY, and a professor in the department of emergency medicine at the University of Rochester.

"These issues are all hanging over (physicians') heads," Schneider added. "Physicians are going to very, very careful to see where the funding around Medicare is, and how, when, and if they are going to get paid," Schneider says. "And we're looking to fix the SGR. That's just the debt ceiling on steroids."

As a result of the debt ceiling vote, a 12-member joint commission is charged with trimming at least $1.2 trillion in federal spending over the next decade. The so-called "super committee" is required to recommend the cuts by Nov. 23, and Congress would have until Dec. 23 to vote on the plan. If the committee can't reach an agreement, a 2% cut to Medicare providers would be made automatically.

Then there's the other, and more complicated fiscal issue, the SGR debacle, an annual crisis.

Once again, the SGR payment formula calls for deep reductions in Medicare payment rates, which has been continually delayed. Unless Congress intervenes, the SGR formula will mandate a 29.5% cut in the Medicare physician payment rate on Jan. 1. And once again, physicians say the reductions will drive doctors out of business or force them to stop seeing patients.

Nobody knows what will happen, of course, but it will be a very interesting fall and winter. Physicians are predicting one of the more vigorous lobbying efforts by their groups in sometime, with the ACEP discussions on Capitol Hill just a precursor of things to come.

The SGR is a far greater concern to physicians, says Roland A. Goertz, MD, MBA, FAAFP, president of the board of directors of the American Academy of Family Physicians.  "We've analyzed this and 2% is the automatic rollback if the 12-member committee can't make a decision, or if Congress and the President can't agree," says Goertz, referring to the debt ceiling fallout. "Will 2% (reduction) make a difference? Well certainly, it will, but nowhere near the difference that the SGR would make at 29.5% if it's not dealt with."

 "We are trying to make a case to have this 'fix' for five years, to put some sensibility into the system," Goertz says, referring to the SGR.  He adds that it would be sensible if the super committee also addressed the SGR issue.

 "I don't see anywhere that the super committee can't deal with the SGR either. Those 12 (super committee members) will be subject to the most intense lobbying effort by everybody who has a stake in this game," Goertz says. "It means everybody and anybody will be going to DC. Every organization is going to be afraid not to be there, for fear of not being heard. It's going to be a very pressure-packed period of time."

One of the problems is that the government is not being responsive in finding ways to reduce healthcare costs, Goertz says.  His organization emphasizes that patient-centered medical homes and related models "have been shown to save millions of dollars," Goertz says. "I'm chagrined why the (healthcare) system isn't moving faster in that direction."

"We need to reduce "public rhetoric or public posturing," he adds."Every physician can tell you about waste that can be fixed. I hope we can get some sort of reprieve."

Physician groups will probably join together to stop funding cuts.  ACEP's Schneider acknowledges each group has its own priorities, but often with overlapping problems. For instance, at least 97% of primary care physicians refer patients daily to the emergency department, according to a poll of 20,000 emergency physicians released by the ACEP in April.  That's because there are too few primary care physicians, Schneider says. And then there are other matters, such as the progress of medical liability reform, which impacts physicians of many specialties, she says.

Those issues were among the reasons why Schneider and her group went to Capitol Hill to begin with, and why they will do so again, with the debt ceiling crisis added to the agenda.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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