AMA Efforts Not Appreciated?

"Your Senators are telling us that they are not hearing from physicians about the looming Medicare physician payment cuts.
So let’s make sure they get the message: now is the time to include positive Medicare physician payment updates in the Medicare bill that is being put together!"
AMA Grassroots Legislative Alert

Dear Friends and Colleagues;
In the last few days I have read several e-mails blaming our AMA for the looming Medicare cuts and and in one of those e-mails the author even suggest that
" the AMA likes to have this issue every year as it allows them to say they did something."
Lets examine the facts before we engage in self-destructive behaviors that will prevent us from achieving our goals.
A recent AMA News article http://www.ama-assn.org/amednews/2007/11/19/gvl11119.htm reviews the current status of the Medicare physicians reimbursement battle. In this article American Medical Association Board of Trustees Chair Edward L. Langston, MD states that " Congress must step in to replace the cut with payment increases that keep up with medical practice costs. Next year's 10.1% physician payment cut is bad news for America's seniors as 60% of physicians say the cut will force them to limit the number of new Medicare patients they can treat."Dr. Langston suggested using $54 billion in what doctors view as excess payments to private Medicare health plans to offset the cut. These Medicare Advantage plans received 112% of the amount that traditional Medicare paid for each senior's care in 2006. The AMA News also published his opinion piece http://www.ama-assn.org/amednews/2007/11/05/edsa1105.htm regarding the Medicare Advantage Plans. Congress needs to level the playing field between traditional and private Medicare plans by eliminating excess payments to Medicare Advantage plans in the amount of $54 billion! This money would be MORE than enough to offset eliminating the the two-year cut in physicians reimbursement.Cuts to Medicare Advantage health plans' payment would also have lowered Medicare's regional benchmark payments to insurance companies, ended a stabilization fund used to share risks with insurance companies and eliminated indirect medical education payments to teaching hospitals.
But what are the political REALITIES we are faced with:

* In the House, an Energy and Commerce Committee staff member said leaders are sticking with the Medicare physician pay provisions adopted as part of its State Children's Health Insurance Program reauthorization bill in early August. The measure would have increased reimbursement 0.5% in 2008 and 2009 each.But the provisions were removed in the House-Senate compromise SCHIP bill in an attempt to maintain a veto-proof Senate majority.
* Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, would prefer to adopt a two-year payment fix by shifting some Medicare Advantage payments to fund physician reimbursement.But many Senate Republicans OPPOSE cutting private health plan payments therefore making it almost impossible to free additional funds to prevent the looming Medicare reimbursement cuts.
* Today, there are more than eight million seniors enrolled in the Medicare Advantage program that provides more services at a lower cost than traditional Medicare, but are often more limited in the health care providers available.An insurance industry sponsored survey revealed that more than 8 out of 10 survey respondents (84 percent) said they are happy with their healthcare coverage and 75 percent would recommend Medicare Advantage (MA) plans to their friends or family members.The survey also shows that beneficiaries believe sustained funding for the MA program is crucial, and nearly all survey respondents said it is important for Congress to work to maintain adequate funding for the program. Many worry that Medicare cuts could mean they could not afford to pay the bill for an unexpected illness (48 percent) or afford prescription drugs (45 percent). Our OPPOSITION to the MA program may backfire on us and we need to carefully navigate between reducing funding for the program and the popular support among seniors for the MA program. Any MA cuts will results in higher premiums for seniors who are already hit with a >20% premium increase for the Medicare part D program.

What can physicians do? TO SUPPORT OUR AMA in its effort to prevent the looming cuts by enrolling in the Grassroots network http://capwiz.com/ama/issues/alert/?alertid=10510101.
We need to flood the offices of senators to impress upon them that the Medicare cuts will limit access to health care services for seniors. They need to understand that those seniors will vote in the upcoming elections and their vote may be influenced by the Senates inactivity and intransigence.

PROMPT PAYMENT LAWS:

Our AMA is also vigorously lobbying for federal prompt-payment laws to close the loopholes of a system that resembles a swiss cheese.
See http://www.ama-assn.org/amednews/2007/11/05/gvsa1105.htm . Insurers have found loopholes to get around the state endorsed prompt-payment deadlines and are using federal law to slip out of state laws.
What is needed is a tough federal law penalizing insurance companies that delay payment.
One reason insurers can ignore prompt-payment laws is that they dominate the market in most communities, says Cecil B. Wilson, MD, immediate past chair of the AMA Board of Trustees. It gives them tremendous negotiating power and prevents physicians from addressing unfair payment practices. The situation, called an oligopsony, occurs when only a few buyers operate in a market with many sellers.
Another problem is that many health plans are not subject to state prompt-pay laws. The federal Employee Retirement Income Security Act exempts companies that self-insure from state insurance laws. About 55% of workers have such coverage, according to the 2007 Kaiser Family Foundation Employee Health Benefits Survey. The percentage rises with firm size: 77% of workers at businesses employing more than 200 people are in self-insured plans.
In addition, many health plans are not subject to state prompt-pay laws. The federal Employee Retirement Income Security Act exempts companies that self-insure from state insurance laws. About 55% of workers have such coverage, according to the 2007 Kaiser Family Foundation Employee Health Benefits Survey. The percentage rises with firm size: 77% of workers at businesses employing more than 200 people are in self-insured plans.

A federal law would fill the loopholes. Or very own Cecil Wilson,MD outlined the elements of a proposal when testifying to the House Small Business Committee's health panel in August:

* A strong federal standard. The AMA's policy is to support legislation that requires payment within 30 days for clean paper claims and 14 days for clean electronic claims.
* Stiffer fines than those in state laws to deter bad behavior. Interest should be assessed on the amount of payment outstanding and increase with the claim's delinquency. Physicians' attorney's fees and costs also should be provided when they win a claims dispute with an insurer.
* State law protections. Stronger state laws should be protected, and state requirements not covered by a federal standard should not be preempted.
* Application of state laws. Any federal law should clarify that state prompt-payment laws apply to all nongovernment health plans, denying insurers the argument that ERISA preempts state law.
* Time limits for notification. Federal law should set a statutorily defined time limit for insurers to notify physicians that additional information is needed to process a claim. The notice should specify all problems with the claim and give an opportunity to provide the information needed. Insurers also should be required to pay any portion of a claim that is complete and uncontested.


In these critical times it would be politically suicidal to divide organized medicine because some have "ideological differences" with AMA policies.
Political rigidity will hurt us. We need experienced leaders that can skillfully execute political decisions, are able and willing to reach reasonable compromises and achieve incremental change.
I hope that I am not alone stating that opinion and I call upon all of you to join our AMA in this struggle.

Yours

Bernd
FMA AMA Delegate