CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage at the meeting.
Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee for service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”
Such a fee-for-service option would allow physicians to “balance bill”—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.
In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.
According to the resolution, the AMA must present the legislative language to its members by Sept. 30.
Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.
Patients “want the conversation about health care to come from their doctors,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin.
“I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” she added.
At a “Write Coat Rally” prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.
“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting.
He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.
At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.
Support for the resolution during the voting session was strong but not unanimous. AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”
He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.
“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.
Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.
“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments.
“None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid; it's going to make us look greedy; it's going to come back and haunt us.”
According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least.”
Dr. Jeffrey W. Cozzens of the American Association of Neurological Surgeons added, “By having legislation that we wrote, we'll show the world that we have solutions to this problem.”
Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”