TEXAS MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution 408 (A-07)
Subject: Medicare Reimbursements
Introduced by: Harris County Medical Society
Referred to: Reference Committee on Socioeconomics
Whereas, Medicare payments to physicians are required to be modified annually by application of the sustainable growth rate (SGR) formula; and
Whereas, Flaws in the SGR mandate physician fee schedule cuts every year which must be averted by last-minute Congressional action; and
Whereas, Physicians are the only provider group whose reimbursement dollars come from resources that are adjusted annually by Congress (Part B); and
Whereas, Commercial insurance providers often base their fee schedules on Medicare rates; and
Whereas, Since 2001 physician costs have risen 18 percent while Medicare payments have declined 5 percent; and
Whereas, Medicare beneficiaries are expected to grow by 35 percent by 2020 and nearly double by 2030; and
Whereas, The flawed SGR system results in a decrease in the quality of care by encouraging a reduction in utilization; and
Whereas, This flawed system forces a conflict of interest to exist between abandoning patients and maintaining a practice; and
Whereas, The percentage of physicians participating in the Medicare program has been steadily declining; and
Whereas, Texas physicians, through the Texas Medical Association, have requested action at the national level on appropriate Medicare reimbursement rates; and
Whereas, In the announcement of its "Principles for Reform of the U.S. Health Care System," the American Medical Association makes no mention of physician reimbursements or fixing the SGR; therefore be it
RESOLVED, That the Texas Medical Association request that the American Medical Association make meaningful Medicare reform its top priority and address the inequities of the Medicare system, including, but not limited to, studying the joining of Medicare A and B, eliminating the SGR, and tying physician fees to the Medicare Economic Index.
Relevant TMA policy
240.016 Medicare Reimbursement Rates : The Texas Medical Association will work to reform the Medicare payment system to provide adequate and equitable funding to all physicians providing services to patients who are Medicare beneficiaries (Substitute Res. 401-A-03).
Relevant AMA policy
H-330.932 Cuts in Medicare and Medicaid Reimbursement : Our AMA: (1) continues to oppose payment cuts in the Medicare and Medicaid budgets that may reduce patient access to care and undermine the quality of care provided to patients;
(2) supports the concept that the Medicare and Medicaid budgets need to expand adequately to adjust for factors such as cost of living, the growing size of the Medicare population, and the cost of new technology;
(3) aggressively encourages CMS to affirm the patient's and the physician's constitutional right to privately contract for medical services;
(4) if the reimbursement is not improved, the AMA declares the Medicare reimbursement unworkable and intolerable, and seek immediate legislation to allow the physician to balance bill the patient according to their usual and customary fee; and
(5) supports a mandatory annual "cost-of-living" or COLA increase in Medicaid, Medicare, and other appropriate health care reimbursement programs, in addition to other needed payment increases. (Sub. Res. 101, A-97; Reaffirmation A-99 and Reaffirmed: Res. 127, A-99; Reaffirmation A-00; Reaffirmation I-00; Reaffirmed: BOT Action in response to referred for decision Res. 215, I-00; Reaffirmation A-01; Reaffirmation and Appended: Res. 113, A-02; Reaffirmation, A-05)
TMA House of Delegates: TexMed 2007