AMA Ads Push for SGR Elimination

The American Medical Association has launched a national media campaign urging the public and physicians to tell Congress to repeal the sustainable growth rate Medicare payment formula before 30% cuts go into effect on Jan. 1.

"We believe Congress needs to come forward with honest accounting at this point and really clear the books on the SGR," AMA Chairman Robert M. Wah, MD, told HealthLeaders Media. "This has been with us for a decade and the problem is that the cost of what they have done so far has just gotten bigger.

Five years ago this problem could have been solved at a cost of about $48 billion. Now to fix it they say it will cost $300 billion. But if they don't deal with it and it goes another five years, the costs will go up to $600 billion."

AMA also rejected a nonbinding recommendation to Congress this month from the Medicare Payment Advisory Commission to kill the SGR and replace it with an equally contentious plan that would include reimbursement cuts to specialists and pay freezes for primary care physicians.

If no action is taken on the SGR and other budget deficit issues by Jan. 1, automatic 30% Medicare reimbursement cuts to physicians are supposed to be implemented, but it's not clear if Congress will allow that to happen.

Instead of cuts or freezes, AMA wants the 12-member budget deficit reduction "super committee" in Congress to provide physicians with a five-year "stability period" on Medicare reimbursements that would include modest inflation adjustments.

"That is what we seek to do with our three-prong plan, which is to repeal the SGR, get five years of stable Medicare payments with inflationary updates, and during those five years work on delivery system improvement and reform that delivers cost effective care for patients in a more coordinated fashion," Wah says. "Then we can fashion a payment system that would facilitate that new deliver system."

Also this week, AMA said in a letter the Centers for Medicare and Medicaid Services that it wants Medicare to start paying doctors for four types of coordination services because they avoid more expensive patient care in the hospital down the line.

The services include responding to telephone calls seven days or more after a patient sees the doctor, education and training to enable patients to better manage their own health, better management of anticoagulation drugs such as warfarin, and time spent coordinating team-based care when the patient is not present.

Wah says physicians are already paid about 20% below cost for their Medicare patients, and taking further reductions could gravely impact patient access.

That is the theme of an ad campaign that AMA unveiled this month. The two-week long media campaign, which was launched Friday, features 30-second television ads on cable and broadcast television in select markets, along with 60-second radio spots.

The television ads – clearly aimed at Medicare beneficiaries -- show an elderly man floating through the sky hanging on to a few dozen balloons that are popped one-by-one. As he sinks helplessly toward the tree line, his face more alarmed with the descent, a voiceover says: "Medicare keeps many seniors afloat. But Medicare payments to doctors are scheduled to be cut by 30% in January. It means doctors may have to limit the number of Medicare patients they see, or even stop seeing them all together to keep their doors open. Tell your representatives in Washington to stop the cuts and find a permanent solution for Medicare that safeguards healthcare access for America's seniors now and forever."

Wah says the super committee could actually provide the impetus for change that has been lacking in Congress in the 10-year battle over the SGR. "One thing that is different now is that the super committee has some things in its favor to expedite getting things done that we don't normally see in the standard process that Congress follows," Wah said.

"The fact that they don't have to be under the cloture rules or the filibuster or that business means that things can get done through the super committee process that we had not see get done in the regular process. This is a unique opportunity for Congress to fix what both parties have said they need to fix and finally fix permanently the SGR. This is an opportunity with the structure that is in place to get this done."

Wah acknowledges that eliminating the SGR would create a $300 billion hole in the budget. However, unlike the American Hospital Association, which last month suggested that Congress raise taxes or the Medicare eligibility age before it cuts hospital Medicare reimbursements, Wah says AMA is steering clear of any specific recommendations. "There is a list of options that have been identified by those groups that the super committee can look at to reduce the deficit and repeal the SGR," he says.

"As a physician I am interested in telling Congress what is best for my patients and my practice and I leave the decisions for how to accomplish that up to Congress. That's part of what they're elected to do."