WASHINGTON – Expert members of the Medicare Payment Advisory Commission voted Oct. 6 to present their Medicare physician pay fix plan to Congress, despite the objections of primary care and specialist physician organizations.
First presented at the commission’s September meeting, the MedPAC recommendations aim to, among other things, avoid the looming almost-30% Medicare pay cut on Jan. 1 under the Sustainable Growth Rate (SGR) formula.
To do so, the commissioners advise freezing most Medicare payments to primary care physicians for 10 years and cutting specialists’ payments by 17% over 3 years, followed by a freeze for 7 years more.
The recommendation passed by a vote of 15-2.
Physician organizations said the recommendations are a less than adequate alternative to the current system.
"The MedPAC proposal, we believe, will unintentionally undermine the goal of transitioning to new payment models aligned with value," said Shari Erickson, director of regulatory and insurer affairs for the American College of Physicians.
"The proposal is not an acceptable or sustainable solution to the SGR and does nothing to promote quality or resource stewardship," said Dr. Jack Lewin, CEO of the American College of Cardiology, in a statement. "Looming primary care shortages require focused solutions, we agree. But this proposal somewhat misaligns the interests of primary and specialty doctors, rather than focusing on incentives to work together to improve quality, efficiency, coordination of care, and outcomes."
Prior to the meeting, a coalition of physician groups, led by the American Medical Association, wrote to MedPAC Chairman Glenn Hackbarth urging that the commission not adopt their proposed recommendations.
Instead, the physicians urged the commissioners to look at previous proposals put forth by groups such as the Congressional Budget Office, the Simpson-Bowles Commission, and the Senate Gang of Six.
MedPAC commissioners also voiced their disapproval of the recommendation for pay cuts and freezes.
Dr. Ronald D. Castellanos, a commissioner and a Florida urologist, said he considered it "extremely disturbing" that a nurse practitioner that he may hire could make more money from treating the same patients, simply because of codes. He added that he believes the cuts would push some doctors into early retirement and discourage medical school students from becoming physicians.
"I think [there are] going to be a lot of doctors, like myself, who are going to say, it’s just not worth any more," Dr. Castellanos said.
With a $200 billion price tag, the MedPAC recommendations reduce the estimated cost of replacing the SGR by $100 billion, according to a MedPAC staff document. Outside of pay cuts and freezes, the proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.
For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), postacute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).