Organized Medicine Seeks Medicare Reform

TMA joined the American Medical Association and 108 other state and specialty medical societies in urging Congress to not just repeal the flawed Medicare payment formula, but to replace it with a system grounded in a set of core principles essential to creating a "high-performing" Medicare program.

Although it wants the Sustainable Growth Rate (SGR) formula eliminated, "the physician community recognizes that this is only one-half of the equation," the groups say in an Oct. 15 letter to the chairs and ranking members of the Senate Finance and House Ways and Means and Energy and Commerce committees. Successful delivery reform that provides patient choice also is a must, along with new payment models that reflect the expense of providing services, as well as efforts to improve quality and manage costs, they add.

The letter warns that the SGR is an "enormous impediment" to reform efforts such as patient-centered medical homes, accountable care organizations, and shared savings programs The formula does not keep up with the cost of care, and the constant threat of steep cuts and last-minute congressional action creates an environment of uncertainty for physicians, their senior patients, and access to care.

Medicare payments to physicians will be cut 27 percent on Jan. 1 unless Congress intervenes as it has for the last decade to stop SGR-mandated fee reductions.

The letter says physicians want to ensure a "robust transition period that can fill the gap" between eliminating the SGR and implementing a new, nationwide system. That transition plan should include elements that reflect the diversity of physician practices and give physicians the freedom to choose a model that works for their practices and patients, and encourage incremental changes with positive rewards, instead of using penalties to order abrupt changes in care delivery.

Any new system should allow physicians to take a leading role in health care delivery, while offering a way for them to measure, demonstrate, and achieve rewards for progress on quality and costs, the letter said. Among other criteria, physicians also want to see that new federal policy promotes structures that:

  • Reward physicians for reducing costs;
  • Tie incentives to physicians' own actions, not the actions of others or factors beyond their influence;
  • Encourage systems of care, regional collaborative efforts, and primary care and specialist cooperation while preserving patient choice;
  • Allow specialty and state society initiatives to be credited as delivery improvements and recognize the central role of the profession in determining and measuring quality; and
  • Provide exemptions and alternatives for physician practices for which the investments necessary to reform care delivery would constitute a hardship.

 Action, Nov. 2, 2012