After years of AMA advocacy, the nation’s leaders are working on plans to eliminate the sustainable growth rate (SGR) formula and revitalize the Medicare program for patients and physicians.

“The time is ripe for eliminating Medicare’s failed payment formula,” states AMA president Jeremy A. Lazarus, MD. “And the AMA will not rest until a new payment system is put in its place to promote the sustainability of physician practices and enable the highest quality care for all patients.”

Read Dr. Lazarus’ blog post.

There are a total of 20 physician members of the 113th Congress including three senators, 16 representatives and a delegate. Learn more about the physician members of Congress by connecting with them on Facebook, Twitter and YouTube.

House of Representatives

Rep. Dan Benishek, MD (R-MI-01)
General Surgery

Rep. Ami Bera, MD (D-CA-07)
General Practice

Rep. Charles Boustany, MD (R-LA-03)
Cardio-Thoracic Surgery

Rep. Paul Broun, MD (R-GA-10)
Family Medicine

Rep. Larry Bucshon, MD (R-IN-08)
Thoracic Surgery

Rep. Michael Burgess, MD (R-TX-26)
OB/GYN

Rep. Bill Cassidy, MD (R-LA-06)
Gastroenterology

Del. Donna Christensen, MD (D-VI-AL)
Emergency Medicine

Rep. Scott DesJarlais, MD (R-TN-04)
Family Medicine

Rep. John Fleming, MD (R-LA-04)
Family Medicine

Rep. Phil Gingrey, MD (R-GA-11)
OB/GYN

Rep. Andy Harris, MD (R-MD-01)
Anesthesiology

Rep. Joe Heck, DO (R-NV-03)
Emergency Medicine

Rep. Jim McDermott, MD (D-WA-07)
Psychiatry

Rep. Tom Price, MD (R-GA-06)
Orthopedic Surgery

Rep. David “Phil” Roe, MD (R-TN-01)
OB/GYN

Rep. Raul Ruiz, MD (D-CA-36)
Emergency Medicine

Senate

Sen. John Barrasso, MD (R-WY)
Orthopedic Surgery

Sen. Tom Coburn, MD (R-OK)
Family Medicine

Sen. Rand Paul, MD (R-KY)
Ophthalmology

On Jan. 1, Congress reached a last-minute deal to avert a 26.5 percent Medicare payment cut which would have severely hurt access to care for Medicare beneficiaries. Current Medicare payment rates have been extended through Dec. 31, 2013.

Read a summary of the Medicare and other health provisions.

While Congress was able to delay drastic cuts for one year, their work is not complete. The current structure of the Medicare program is increasingly unreliable for physicians and patients. The routine delays, last-minute actions and “kick the can” approach by Congress only reinforces the need for change and long-term reforms in the Medicare program.

The newly elected members of the 113th Congress will take office this week and have the opportunity to work in moving Medicare towards a more reliable and stable system that preserves patients’ access to care. Pressure must remain on lawmakers to permanently repeal the sustain growth rate (SGR) formula and enable common sense, sustainable Medicare reforms in 2013.

The Patients’ Action Network will continue to provide the latest information on the path to repeal of the SGR and reforming Medicare. Stay tuned for new action alerts and ways to remain engaged with your lawmakers. Thank you for your phone calls and emails to Congress on behalf of patients and preserving access to care.

Congress’ lame-duck session is forcing lawmakers to make important decisions affecting the future of medicine before a new Congress convenes in 2013.

Tough decisions will have to be made, but the AMA’s position is clear: Lawmakers on both sides of the aisle must make stopping a 26.5 percent cut to Medicare physician payments, driven by the flawed sustainable growth rate (SGR) formula and scheduled for Jan. 1, a top priority. They also must put in place a transition to a higher-performing Medicare program, beginning with permanent repeal of the SGR.

You can help. Contact your members of Congress through the Patients’ Action Network website or by using the the grassroots hotline: (888) 434-6200.

Urgent issues on the table revolve around the so-called “fiscal cliff,” which threatens a number of drastic tax and spending policy changes, including:

• Across-the-board spending cuts under the Budget Control Act of 2011. Required to total $109 billion per year, these cuts affect both defense spending and domestic programs, including a 2 percent cut to Medicare physician payments.
• Expiration of the Bush 2001 and 2003 tax cuts. The tax cuts include individual rates, capital gains, dividends, child tax credit expansion, marriage penalty reduction and the estate tax.
• a patch to the alternative minimum tax. If left unchanged, 28 million Americans would face a hefty additional tax liability.
• Expiration of the 2 percent payroll tax cut.
• Medicare physician payment cuts of 26.5 percent, which are called for under the sustainable growth rate (SGR) formula.
• Miscellaneous business tax provisions (also referred to as “tax extenders”).
• Unemployment benefit extension.
• Affordable Care Act tax provisions.

A critical piece of this is putting a stop to the Medicare physician payment reductions—totaling nearly 30 percent between the Budget Control Act and SGR cuts—that threaten physicians and their patients. Comprehensive reform of the Medicare physician payment system is sorely needed. And physicians are ready to lead the way toward a new and innovative models that will stabilize the Medicare program and promote high-quality, high-value care.

But first, Congress must act responsibly and stop the scheduled Medicare SGR cuts before it’s too late.

Last week Congress passed a 10-month patch to the flawed sustainable growth rate (SGR) formula stopping a potentially devastating 27 percent cut in Medicare payments to physicians on March 1 that would have negatively impacted seniors’ access to care and choice of physician. This agreement was part of a larger legislative package tied to the extension of the payroll tax cut and unemployment benefits.

This latest agreement is the 14th short term patch to the SGR in the last 10 years. The Patients’ Action Network will continue to urge Congress to once and for all repeal the SGR and stop this terrible cycle that continually threatens seniors access to critical care.

AMA President Peter W. Carmel, MD, issued the following statement:

“The House and Senate conference committee agreement averts a 27 percent cut on March 1, but it represents a serious missed opportunity to permanently replace the flawed Medicare physician payment formula and protect access to care for military families and seniors. People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion.

“Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice. We appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem. We are deeply disappointed that Congress chose to just do another patch — kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients. Shortly after the coming elections, access to care for seniors and military will again be threatened by an even larger cut, and members of Congress will need to take swift action to end the broken formula.”

Now more than ever, it is critical for grassroots America to remain engaged on this incredibly important issue. Your active participation in calling and emailing your representatives and senators over the last several months and urging Congress to repeal the SGR is helping to build political momentum. With your continued support, we will repeal the flawed SGR and protect patient’s access to care and choice of physician.

Stay tuned for future “calls to action” and legislative alerts.

Seniors may lose their choice of physician on March 1st and physicians will face a 27.4% cut if Congress does not act to protect Medicare. Watch our new ad below and then take action! Tell your Representative and Senators that growing the problem is not the solution – stop the Medicare payment cuts! Email them and then call them using the Patients’ Action Network hotline at (888) 434-6200.

This month a House-Senate Conference committee will begin meeting as early as January 17th to resolve outstanding issues on pay roll taxes, unemployment insurance, and Medicare’s flawed SGR forumla.

There continues to be bipartisan interest in taking this opportunity to repeal the SGR, utilizing in whole or in part the excessive funds included in the current baseline for Overseas Contingency Operations, or OCO.

It is critical that we encourage the efforts of those in the House and Senate who support repeal of the SGR and who recognize that continued temporary patches drive the costs of eventual repeal higher by tens of billions of dollars every time it is delayed.

Learn more about why we need to fix the flawed SGR formula:
Now is the time to fix SGR
Implications of a one-year Medicare patch
Implications of a two-year Medicare patch

The U.S. House of Representatives on Tuesday rejected a Senate bill that would have averted a 27.4 percent Medicare physician payment cut scheduled for Jan. 1, leaving 2012 Medicare payment rates in limbo. A House-Senate conference committee will now be charged with working out differences between the two versions of the bill.

With both the House and Senate adjourning for the holidays, it does not appear likely that the outstanding issues will be resolved before Jan. 1. The House is scheduled to return to Washington on Jan. 17, while the Senate is scheduled to return on Jan. 23. However, there are reports that the House may move the date of its return up to Jan. 3.

The Centers for Medicare & Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days—until Jan. 17—to avoid processing payments at the lower rate. After that date, claims will be processed on a first-in, first-paid basis at the reduced rates until the situation is resolved.

The AMA reaffirms its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal the flawed and disruptive formula once and for all.

“It is long past time for members of Congress to act decisively and protect access to care for seniors and military families,” AMA President Peter W. Carmel, MD, said in a statement.

Stay tuned for further updates and ways to get involved.

Physicians got a brief reprieve from a 27 percent Medicare pay cut as the U.S. House of Representatives reached agreement with the Senate on a two-month extension of important policies that expire on Jan. 1.

AMA President Peter W. Carmel, MD, called on Congress to “enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for taxpayers. Members of Congress need to use this time to work in a bipartisan manner to provide long-term stability for seniors, military families and the physicians who care for them.”

Stay tuned for further updates and for ways to get involved to end this cycle of short-term Medicare patches.

With the Joint Select Committee on Deficit Reduction failing to reach agreement on a deficit-reduction proposal, physicians still face a 27 percent cut in Medicare physician payments scheduled to take effect Jan. 1. Congress has missed an opportunity to address the nation’s fiscal problems, stabilize the Medicare program and permanently repeal the sustainable growth rate (SGR) formula.

“The deficit committee had a unique opportunity to stabilize the Medicare program for America’s seniors now and for generations to come,” AMA President Peter W. Carmel, MD, said in a statement. “Once again, Congress failed to stop the charade of scheduled annual physician payment cuts and short-term patches that spend more taxpayer money to perpetuate a policy all agree is fatally flawed. A decade of uncertainty and repeated threats of steep cuts threaten access to care for seniors and military families who rely on the Medicare and TRICARE programs.”

Proposals to repeal the SGR fell victim to disagreement over fundamental principles for achieving deficit reduction. Sharp partisan division over the mix of entitlement cuts and tax hikes prevented the supercommittee from reaching any agreement on a deficit-reduction package.

Congressional action expected to avert 27 percent cut on Jan. 1

Democratic and Republican leaders in Congress have publicly stated their commitment to take action this year to avert the 27 percent cut. Options for SGR relief outside of the supercommittee process have ranged from short-term patches of a year or two to longer-term relief that provides for transition to a new Medicare physician payment system.

The scope of the next SGR intervention will not come into better focus until Congress returns from its Thanksgiving break. Congress has a number of items of unfinished business that require action before departing for the Christmas holidays. Stay tuned for future updates via the Patients’ Action Network.

What can you do at this juncture?

Register your strong concerns with your members of Congress that yet another SGR deadline is approaching and Congress has yet to act. Call the Patients’ Action Network hotline at (888) 434-6200 and ask your representatives and senators what specific steps they will take to end the annual SGR fiasco.

If they tell you that they are “with you,” remind them about the multiple missed deadlines in 2010. Patients and physicians need action rather than vague expressions of support.

Thanks for past grassroots efforts; frustration, fatigue understandable

Thanks to all of you who have responded to our calls to action. Your hard work has helped us generate a massive grassroots outcry from both physicians and patients on behalf of SGR repeal, with more than 250,000 email and phone call contacts to Congress on this issue in just a few months. Keep up the good work!