Monday, December 18, 2017

OCMA Blog

MEDICARE SGR ALERT: Physicians: Call Congress Now!

PROTECT ACCESS TO CARE IN CALIFORNIA


DON'T PATCH IT, REPEAL IT!

MEDICARE SGR REPEAL AND PAYMENT REFORM: HR 4015/S 2000

 

Physicians: Call Congress Now! (800) 833-6354 (Takes 2 Min)

UPDATE MARCH 11, 2014:
House Republican leaders have scheduled a vote for this week on H.R. 4015, with a repeal of the ACA individual mandate as the funding source. (If the mandate is repealed, the government will spend less on premium subsidies and thus, a substantial cost savings will occur.)

This repeal of the ACA is not an acceptable, viable funding option in the U.S. Senate. Knowing that the ACA repeal will not be accepted, House leaders have scheduled a second vote at the end of March to adopt another nine-month patch.

CMA is urging Congress to find bipartisan funding sources. We are opposing another nine-month patch. CMA is calling upon Congress to Fix Medicare Now!

A long-awaited and hard-fought bill to permanently repeal Medicare's fatally flawed sustainable growth rate (SGR) formula finally is before Congress. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000) offers a fiscally prudent opportunity for lawmakers to repeal the SGR formula and put Medicare on the path toward a stable, 21st-century program that can meet the growing health care needs of the nation's seniors.

This is the most progress Congress has made in a decade. We must seize this opportunity and make a final push to get this bill passed NOW. To sustain the bipartisan momentum, your Congressional representatives need to hear from you.

There are many powerful groups that are pushing back, objecting to Congress' plans for funding the physician payment fix. That's where you come in. To overcome the opposition, Congress needs to hear from a large volume of physicians. Every single physician needs to call and email the California Senators and your Member of Congress NOW!

Congress has a significant opportunity to finally repeal the SGR and enact payment reform. Why?

  • The cost to repeal the SGR is at an all-time low of $116 billion - down from $238 billion.
  • Congress has already spent $154 billion over the last decade adopting short-term patches to stop the SGR cuts - more than the total cost to repeal the SGR. It is fiscally irresponsible to adopt another one-year SGR patch. The Wall Street Journal calls the "patches" a sham.
  • There is a bipartisan, bicameral agreement on legislation to establish a new payment system.
  • The deadline is March 31, 2014, when the next 24 percent SGR cut occurs.

But reform won't happen unless Congress hears from thousands of physicians!

Physicians must call Congress to fix Medicare now!
To overcome the partisan funding proposals and the other opposition, Congress needs to hear from a large volume of physicians. Every physician needs to call and email the California Senators and your Member of Congress NOW! Please make as many calls and send as many emails as possible. Every one makes a difference! We are asking physicians to call/email the following individuals:

  • Your local congressional representative (use your local zip code)
  • California Senator Barbara Boxer
  • California Senator Dianne Feinstein
  • House Republican Whip Kevin McCarthy (zip code 93309)
  • House Democratic Leader Nancy Pelosi (zip code 94103)

To contact members of Congress:
Call AMA's Grassroots Hotline, (800) 833-6354, to be connected with your members of Congress in Washington. You will be asked to enter your zip code and select your representative. You are also encouraged to call your representatives in their local district offices (click here to download a current telephone roster).

You may also email your federal legislators via the AMA's "Fix Medicare Now" grassroots website. Utilizing the sample letter provided, it takes no more than two minutes.

Urge Congress to tell their House and Senate leadership to:
1. Protect access to care in California and enact Medicare physician payment reform NOW.
2. The cost to fix the Medicare SGR is at an all-time low and there is bipartisan agreement on the legislation.
3. Use bipartisan funding sources.
4. Oppose another one-year SGR patch.

Ask your patients to help:
AMA has also prepared a flyer that you can use to get your patients involved in the fight to protect Medicare. Distribute the AMA's "Fix Medicare Now" flyer to your patients and ask them to call their representatives, too.

Additional information:


ALERT: Legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance & the House Ways and Means Committees

Bipartisan House-Senate Medicare payment reform legislation passes out of committee; Congress includes 3 month patch to stop the 25% SGR cuts in budget deal

The Orange County Medical Association (OCMA) and California Medical Association (CMA) are pleased that legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance Committee and the House Ways and Means Committee yesterday, December 12, 2013. 
 
The Senate Finance Committee and the House Ways and Means Committee this week unveiled revised legislative proposals to repeal the Medicare sustainable growth rate (SGR) and establish a new payment system. Both committees have said that they expect to "mark-up" (pass out of committee) the legislation on Thursday, December 12.  The changes they have made since the initial October "discussion draft" are all positive and address most of the issues raised by the California Medical Association (CMA).
 
Yesterday's committee votes came just before Congress recesses for the holiday, pushing any further action into 2014. Congress has also included a three-month SGR patch-with a 0.5 percent payment raise-as part of the federal budget agreement, which will give lawmakers a little more time to finalize the long-term Medicare payment reforms. The bills are being passed out of Committee without funding sources. When lawmakers return in January, they will begin to marry the funding sources to the Medicare payment overhaul legislation.   
 
"With the drastically reduced price tag of $116 billion, Congress must seize the opportunity to set Medicare on a more stable course for current and future generations of physicians and patients," says CMA President Richard Thorp, M.D. "While the bill still needs work, CMA supports moving the bills through committee to continue to move the process forward. This is the most progress Congress has made on Medicare physician payment reform in a decade and we need to keep the momentum going."  
 
The revised proposals will first and foremost eliminate the badly broken SGR formula that has plagued policymakers and physicians for more than a decade. The legislation also establishes two payment tracks. A fee-for-service payment track coupled with a streamlined reporting program, called the Value Based Performance Program. The bill provides substantial physicians bonuses up to 12 percent. It also includes penalties. (However, existing law includes 8-9 percent penalties for non-participation next year without any bonus potential.)
  
The second payment track allows physicians to work with the Centers for Medicare and Medicaid Services (CMS) to establish alternative payment models, such as medical homes, that will provide 5 percent bonus payments. To help small practices transition to these models, they have provided a transition period and up to $125 million in funding assistance. The legislation also requires CMS to ensure that the new payment systems work for small practices as well as surgeons/specialists and primary care. 

The legislation meets many of CMA's long-standing goals for Medicare reform, including:

  • Repeal of the SGR;
  • Automatic payment updates before the new models begin;
  • Incentives to participate in new payment models (5 percent bonus);
  • A phase-in period and funding assistance to help small practices transition to new payment models;
  • Retention of a fee-for-service program;
  • Elimination of the current penalties and a consolidation of the current quality reporting programs (Physician Quality Reporting Program-PQRS, EHR Meaningful Use, and the Value Modifier) into a single program with a substantial new bonus pool; 
  • Improvements to the Value Modifier;  
  • Payment for complex chronic care management;
  • Timely data feedback for physicians;
  • Ensures that physicians develop the quality measures and are widely consulted on the new payment programs;
  • Update for the Medicare physician payment localities (California GPCI fix).

In response to CMA's comments, the committees made the following additional improvements:

  • Provides increased funding assistance ($125 million) to ALL small practices, not just rural and HPSA practices;
  • Allows a longer time-frame for physicians to prepare to participate in the new models;
  • Gives special consideration to small practices when developing the clinical improvement activities,  the value modifier methodology and the alternative payment models;
  • Requires the fee-for-service value-based program to reduce administrative burden on physicians and gives credit for improvement rather than just meeting a benchmark;
  • Ensures the Value Modifier will be cost and risk-adjusted;
  • Requires CMS to develop models that are attainable for specialists and surgeons, as well as primary care physicians, and small practices; 
  • Allows physicians to partially qualify for the new alternative payment models;
  • Expands the "total cost of care" data available to physicians to help physicians more efficiently manage their practices;
  • A study to examine total Medicare program cost savings (Part A, Part B and Part D) achieved by physicians.
  • Allows physicians to report data on the group level, including virtual groups, to improve the accuracy of the data.
  • Improvements to the Relative Value Unit process; 
  • Ensures that any practice guidelines or payment policies do not establish a standard of care for medical liability actions.

In a last-minute change, the Ways and Means bill now provides a stabilizing 0.5 percent automatic update each year for three years until the new payment models begin. The Ways and Means bill also includes the California geographic payment locality update ("GPCI fix"), which would transition the outdated payment localities to the current and regularly updated metropolitan statistical areas used to calculate payments to hospitals. This transition would take place over 6 years and guarantees that rural counties are not negatively impacted by the change. This GPCI fix would provide an additional $400 million to California physicians over 10 years.

The Senate Finance Committee bill does not, however include an automatic payment update in the first three years. The Senate Chairmen want to wait until the Congressional Budget Office scores the legislation and they negotiate funding sources before adding any payment updates. The Senate bill also does not include the California GPCI fix, as the committee has stated it wants to keep state-specific issues out of the committee mark-up. However, both Senate Finance Committee Chairman Max Baucus and Ranking Member Orrin Hatch have pledged to address the CMA GPCI issue during the January negotiations.  


Announcement: Medicare SGR and GPCI Bill Clears Committee

On Wednesday, July 31, the House Energy & Commerce Committee voted UNANIMOUSLY to approve H.R. 2810, the bill to repeal and replace the Medicare SGR. Included in that bill is a California Medicare locality reform (known as the "California GPCI Fix") which will update payments for the urban physicians in Locality 99 and Locality 3 while holding the rural physicians in these localities harmless from payment cuts. 

 

OCMA and CMA are pleased with this herculean effort to move Medicare SGR legislation on a bipartisan basis as well as update the outdated Medicare physician payment localities.  CMA physicians have cleared the first hurdle in a long legislative process. The Medicare SGR and GPCI Locality  issues will now be taken up by the House Ways & Means Committee as well as the Senate Finance Committee.   

 

While there are several aspects of the bill that concern CMA, including the downside penalties and lack of adequate updates, the bill meets many of the goals that CMA advocated to Congress to eliminate the annual threat of nearly 30% SGR payment cuts, 5 years of stable updates, a continuation of the Fee-for-Service (FFS) program with opportunities for updates, and incentives to help physicians transition to new payment and delivery models. There is still much work to be done on the entire bill and Congress recognizes that.  

 

If you would like further details on this matter, please contact OCMA.

UPDATE: Congress stops Medicare cuts for one year as part of fiscal cliff legislation

This morning (Jan. 3) CMS released instructions to contractors for implementation of the revised fee schedule.  In order to allow sufficient time to develop, test, and implement the revised 2013 Medicare physician fee schedule, Medicare contractors have been instructed that they can hold claims with January 2013 dates of service for up to 10 business days. CMS expects these claims to be released into processing no later than January 16, 2013.  The claim hold should have minimal impact on physician cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Based on prior history of similar fee schedule updates, CMA believes that physicians may expect to see claims paid in approximately 21 days, rather than the usual 14 days. Medicare contractors will be posting the new payment rates on their websites no later than January 23, 2013. 

Congress stops Medicare cuts for one year as part of fiscal cliff legislation

HR 8 is a prime example of the need for physicians to speak with a unified voice through your local and state medical association. Clearly, the work is not over as these are merely temporary fixes. A strong physician perspective is critical in further debates. To the members of OCMA/CMA, thank you for your support and participation in important efforts such as this - it does make a difference. If you are not a member of OCMA/CMA, we need to add your voice to strengthen our advocacy on behalf of doctors and the patients you serve. 


Congress on January 1 passed HR 8, the American Taxpayer Relief Act, narrowly averting the so-called "fiscal cliff." The bill includes a one-year Medicare fee-for-service physician payment freeze, meaning the 26.5 percent sustainable growth rate (SGR) cut has been averted, for now. The 2 percent sequestration cuts have also been deferred for two months.

 

The one-year fix comes with a $25 billion price tag. The cost of physician payment reform has been growing over the years as Congress continues to enact frequent short-terms fixes. As recently as 2005 the cost of permanent reform would have been $48 billion, but today it is estimated to be nearly $300 billion over the next 10 years. If action is not taken soon, the cost will continue to escalate to $500 billion in only a few short years.

 

The one-year freeze will be paid for with cuts to the Affordable Care Act's (ACA) new CO-OP program and other health care programs ($15 billion of the cuts impacting hospitals). At CMA's urging, the ACA's Medicaid increase for primary care physicians was not used to pay for this temporary fix, despite earlier attempts to do so.

The Medicare fix is being paid for by:

  • Cuts to the ACA's CO-OP program (unobligated funds)
  • Extending the statute of limitations for recouping overpayments.
  • Adjusting the equipment utilization rate for Advanced imaging services.
  • Rebasing end stage renal disease payments based on utilization of drugs.
  • Equalizing stereotactic radiology hospital outpatient services with physician services.
  • Rebasing of Disproportionate Share Hospital payments.
  • Reducing multiple procedure payments when more than one therapy procedure is provided on the same day.
  • Eliminating funding for the Medicare improvement fund.
  • Eliminating the ACA long term care (LTC) CLASS act. (But establishes a LTC commission.)
  • Adjusting Medicare Advantage payments to account for differences in coding practices between fee-for-service and managed care risk adjustment formulas.

Importantly, the bill also lays the groundwork for an alternative Medicare payment system by establishing data systems and a registry for reporting on quality that will help physicians.


What does this mean for physician claims?

 

Because federal law requires Medicare contractors to hold claims for 14 days before releasing payment, there should be little if any impact on physicians' cash flow. Although there has been no official word from the Centers for Medicare and Medicaid Services, claims for services provided in the early days of 2013 will likely be processed under the new 2013 fee schedule. Palmetto, California's Medicare contractor, should have the new fee schedule posted on its website in about 10 days.

 

The 2013 fee schedule will not be exactly the same as the 2012 fee schedule. Although Congress stopped the 26.5 percent SGR cut, there were other components of the fee schedule formula that affect payment that may have changed, such as the relative value units (RVUs).

 

Physicians have the option of holding claims and submitting them after the new fee schedule is released. If you choose to submit claims in the interim, the California Medical Association (CMA) suggests that both participating and non-participating physicians bill their usual and customary fees-for-services to Medicare. Billing at your customary fee ensures that Medicare pays the highest amount possible when the claim is processed.


CALL TO ACTION: CONTACT CONGRESS AND URGE THEM TO PROTECT HEALTH CARE TODAY!

Congress has three weeks left to stop the 26.5 percent Medicare sustainable growth rate (SGR) physician payment cuts (to take effect on January 1, 2013) before they adjourn for the holidays. The Orange County Medical Association urges physicians to keep the pressure on Congress to stop these cuts.

Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress.

Description

Members of Congress have returned to Washington, D.C. for a Lame Duck Session to address the so-called "fiscal cliff" issues affecting the future of medicine and our country. These issues must be addressed before January 1, 2013 or the following occurs:

  •  26.5 percent Medicare physician fee-for-service rate cut because of the SGR formula;
  • Across-the-board spending cuts known as "sequestration" - $109 billion/year. While Medicaid is exempt from the sequestration cuts, the Medicare program faces 2 percent cuts; Defense takes $500 million in cuts and the rest comes from domestic programs.
  • Expiration of the Bush 2001 and 2003 tax cuts (including individual rates, capital gains, dividends, child tax credit, marriage penalty reduction, and the estate tax).
  • The Alternative Minimum Tax patch expires.
  • The Social Security Payroll tax cut expires.
  • Unemployment benefits extension expires.

It is important that members of Congress work together in a bipartisan way to resolve these vital issues and avoid going over the "fiscal cliff." Most economists speculate that if Congress fails to act, economic growth will drop significantly, unemployment will rise, and the country will slip back into a deep recession. 

CALL your members of Congress and urge them to work together to stop the Medicare SGR physician payment cut of 26.5 percent and the Medicare sequestration cut of 2 percent before they take effect on January 1, 2013.


How to contact members of Congress:

Phone:  Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress. You will be asked to enter your zip code and select your Representative.

Email: Federal legislators must be contacted via the email forms on their websites: www.writerep.house.govwww.boxer.senate.gov and www.feinstein.senate.gov.


Talking Points

Urge California Senators and your member of Congress to:

  • Repeal the Medicare SGR and stop the 26.5% physician payment cut.
  • Stop the Medicare 2% Sequestration Cut.    
  • Adopt long-term Medicare Payment Reform.
  • Update the California Medicare Geographic Payment Localities.
  • Stop Medicaid and Other Health Care Cuts  


Background

Tough decisions will have to be made in the coming weeks but Congress must make Medicare funding a top priority. We can't allow Congress to ignore the nearly 30 percent Medicare cuts facing physicians and patients in California. Such cuts will certainly harm access to doctors for seniors, military families and potentially all California patients because private insurers follow Medicare. 

 

Moreover, comprehensive reform of the Medicare physician payment system is long overdue. Working together, CMA, AMA, the national specialty societies and state medical associations are currently developing an alternative Medicare payment system that will stabilize the Medicare program and promote high quality, high value care. Physicians are leading the way. But first, Congress must act responsibly and stop the scheduled Medicare SGR payment cut of 26.5 percent. Such cuts seriously threaten the viability of California physician practices and your ability to care for patients. Physicians are also important employers crucial to the California economy.

 

In recent days, Senate and House Republicans have forwarded a proposal to cut the Affordable Care Act (ACA) Medicaid (Medi-Cal) physician payment increase as a way to fund the fiscal cliff issues. CMA is opposed to such cuts. California Medi-Cal rates are already some of the lowest in the nation - 50 percent below Medicare. Because of these low rates, 75 percent of physicians cannot afford to participate in Medi-Cal and thus, 50 percent of Medi-Cal patients can't find a physician. Regardless of the ACA, California needs the Medi-Cal rate increase to protect access to care. 

 

CMA will also be working to stop sequestration budget cuts to other vital health care programs, such as public health and graduate medical education (GME).

 

Finally, CMA is pursuing an update to the Medicare physician payment localities in the Medicare/Budget Sequestration legislative package. California's localities have not been updated and thus, 14 urban counties are still designated as rural and physicians in these counties are paid up to 14 percent less than their urban counterparts.  


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