While most people are focused on the midterm elections Tuesday, the American Medical Association is gearing up for the lame-duck congressional session scheduled to start Nov. 15. Unless Congress intervenes, payments to doctors for treating Medicare patients will be cut by 23 percent on Dec. 1 and another 6.5 percent on Jan. 1.
Cecil B. Wilson, an internist from Winter Park, Fla., who became AMA president in June, is pressing for a 13-month patch that would prevent the Medicare physician cuts. In April, the Congressional Budget Office said that blocking the cuts until January 2012 would cost about $15 billion. A long-term formula fix, through 2020, would cost about $276 billion, it said.
The AMA argues that a 13-month reprieve from the reductions would give it time to work with Congress to overhaul the Medicare payment formula. In recent years the payment formula has called for cuts, but each time lawmakers have stepped in to block them before they took effect or shortly there after. The AMA could use a win on the issue. The organization was sharply criticized by some physicians for endorsing the new health care law without getting the formula straightened out in return.
If Congress doesn't block the looming payment cuts, "this will be a catastrophe," Wilson said, with more and more doctors leaving the program and seniors having a harder time getting in to see doctors.
Whatever happens in the lame-duck session, the new Congress is likely to have more doctors. Currently, there are 16 physicians in Congress, but dozens more are running for the House or Senate this year. That may provide more sympathy for the AMA on the issue, but the cost of fixing the formula may still be viewed as prohibitive. Edited excerpts of the interview with Wilson follow.
Q: What's your strategy in the lame-duck session to get the Medicare physician payment cuts canceled?
A: Our strategy is to say to Congress, "What we want from you is to stabilize Medicare payments to physicians for the next 13 months to get us through 2011." And then that will give us an opportunity working with the new Congress to develop a means of getting rid of the formula, putting in a formula or a payment mechanism that recognizes increased costs of care.
Q: But isn't it highly unlikely that's going to happen? What if Congress goes for a shorter-term fix or doesn't address the payment reduction at all?
A: There is no disagreement in Congress…this formula is not working....What we're saying to them and what we want seniors to say to them is, "You're threatening our access to care. If physicians cannot keep their doors open because Medicare now only pays about half the direct cost of running a practice, then we're going to lose access to care." It will be gut-wrenching for physicians to say, "I can no longer continue to see new Medicare patients." … But that's where we are, and if you're talking about a 30 percent cut if Congress does nothing by Jan. 1, this will be a catastrophe.
Q: The AMA has an item on its website helping physicians think through this very issue - should you stay in Medicare or not? Do you think that if you don't get a 13-month fix, doctors will simply say, "I'm out of this program?"
A: As a matter of fact, I participated in a webinar [recently] in DC. Four hundred physicians across the country were involved in the webinar, in which we talked to them about their options. The reality is between now and the end of December physicians have to make a decision about their status related to Medicare. So we are trying to provide information to [them] so they can make a wise decision. Our concern, of course, is that if Congress in the lame-duck session does not address this problem, or they address it in ways that are disruptive to physicians' practices, more physicians are going to say, "You know, I'm just out of here. I cannot keep my doors open and provide care for other patients."
Q: But your efforts so far haven't worked and now we're in a very severe fiscal situation. Maybe the AMA doesn't have the clout it used to have in Congress?
A: Well, this is not about the AMA; this is about senior citizens who need care. I can just tell you from my own [experience in] Winter Park, Fla., the conversation in the grocery store lines [or] at the shopping mart is, "Do you know any physician who is still taking new Medicare patients?" And the answer is no.
And on the topic of the health law in the post-election landscape:
Q: Of the physicians running for office this year, [the vast majority of them] are Republican. If they win, they will very likely join the other Republicans in Congress who want to see the law either repealed or parts of it repealed and replaced. What do you make of the possibility of such a large group of physicians working against the health law, which the AMA endorsed?
A: Physicians like everyone else in the country have shared differing opinions on health system reform as it unfolded. And in a lot of ways physicians have felt maybe even stronger about it because that's what they do and they're closer to what's happening. And so it's understandable that there will be differences of opinion, we certainly saw that played out during last year and that still is the case this year.
To the question of whether the Affordable Care Act will be repealed I think that everyone would suggest that will be very difficult. ... I think where we are focused is to say this is the law of the land. … What we need to do now is to correct some defects in the law, we need to put some things in that were left out and we need to work very hard in the coming years on the regulations that are going to be responsible for implementing the legislation.
Q: But if Republicans as predicted take the House and increase their numbers in the Senate, they're going to try to make major changes in the law. What would you keep in the law and what would you get rid of?
A: First of all, as I just mentioned, the issue of covering the 32 million people who are not currently covered, the issue of [a] guarantee that insurance companies cannot exclude people based on pre-existing condition, children up to age 26 can be on their parents' policies -- these are really big, and sometimes they get lost in all the bitterness and all the anger about other things that are there, so we would want to preserve that.
In addition, in terms of thinking about things that are there that should not be there, as a matter of fact, would not be there if the process had gone better, this Independent Payment Advisory Board, which would responsible for actually making cuts in Medicare payments. We believe that the way that board is set up, it would not allow for the fact that sometimes there is a reason to provide more care, the population is aging, the increase in chronic disease, new technology, or a pandemic such as influenza. So there's some things that need to be modified in the law to make sure that this new board does not actually make things worse than they are now.