With deep pockets and huge memberships, politically influential physician organizations think they’re on the cusp of achieving something they’ve aggressively sought for years: a congressional cure for a Medicare payment system that regularly threatens to cut their fees.
Lobbyists and physicians are working overtime this week as Congress weighs a bipartisan bill to revamp the Medicare payment formula for doctors and put an end to the so-called “doc fix,” temporary patches approved by lawmakers to stave off cuts in the payments.
“We’ve finally got Medicare’s Sustainable Growth Rate (SGR) formula on the ropes,” Texas Medical Association President Austin King wrote to the group’s members earlier this month. “Let’s deliver the knockout punch right now.”
That punch might come Thursday, when the House of Representatives is scheduled to vote on revamping the program after an expensive, intense effort by physicians’ groups and their political action committees.
They’ve been among the biggest spenders on lobbying and election campaigns in recent years, according to campaign watchdogs. Their top priority has been eliminating a system that they’ve chafed under since the 1990s.
“I’ve heard nonstop from doctors without ceasing since I was a candidate in 2011that there needs to be a permanent fix,” said Sen. Tim Kaine, D-Va. “It has never not been intense. Anything I ever do with physicians – it could be a pediatric, could be an OB-GYN, it could be a researcher – the SGR fix is always the first issue, and sometimes there isn’t a second or third issue.”
Rep. Raúl Labrador, R-Idaho, said, “I’ve heard the argument that if we don’t vote for the doc fix that doctors will campaign against us.”
Repeal of the Medicare Sustainable Growth Rate has long been the main target of the physicians’ lobby. The 232,000-member American Medical Association alone spent $19,650,000 on lobbying last year, according to the Center for Responsive Politics Open Secrets website.
Only the U.S. Chamber of Commerce, the National Association of Realtors, Blue Cross/Blue Shield and the American Hospital Association spent more, according to Center for Responsive Politics data.
The AMA and other physician groups have generously given to election campaigns and to both political parties. The AMA’s political action committee contributed nearly $1,679,800 to House and Senate candidates last year. Sixty-three percent went to Republicans.
"We strongly support the policy to permanently eliminate the SGR and call on Congress to seize the moment and finally put in place reforms that will foster innovation and put us on a path towards a more sustainable Medicare program," AMA President Robert Wah said in a statement.
The American College of Radiology’s political action committee doled out $1,781,750 in campaign contributions last year on top of $3,884,585 in lobbying expenses, according to Center for Responsive Politics figures.
“The amount of money spent is significant,” said Viveca Novak, the Center for Responsive Politics’ editorial and communications director. “But more important, these doctors are knowledgeable and organized, partly through the AMA and other groups, and they contact members of Congress.”
And lawmakers have consistently been getting an earful from the medical lobby. The volume increased Tuesday as the AMA launched a “National Call to Action Day,” urging doctors and patients to contact their elected officials and press them to support the “doc fix” remedy that’s part of a $210 billion bill backed by House Speaker John Boehner, R-Ohio, and House Minority Leader Nancy Pelosi, D-Calif.
The doc fix involves formulas to compensate doctors for treating Medicare patients. It’s supposed to be adjusted to reflect changes in the cost of health care.
To control costs, such “fixes” are supposed to mean limits in physician reimbursements. But doctors complain, arguing that the cuts would force them to stop treating Medicare patients. Congress relents, and the fixes usually mean higher payments.
Congress has voted for the “doc fix” 17 times over the last 12 years. The new bill would scrap the Sustainable Growth Rate formula and replace it with a system that rewards doctors for quality care over quantity care.
If the House and Senate fail to act on the bill before they adjourn for a two-week spring recess Friday, doctors will face a 21 percent cut in Medicare payments on April 1.
“If enacted, it will permanently replace one of Washington’s most infamous gimmicks – the Sustainable Growth Rate – with a more stable system that ensures seniors have access to the doctors and the quality care they need,” Boehner said Tuesday.
Despite rare bipartisan support and the aggressive lobbying by doctors, the bill still faces some obstacles. Conservative Republicans complain that other revenues offset only $70 billion of the 10-year, $200 billion package.
The Club for Growth, a free-enterprise advocacy group, and Heritage Action, the political arm of the conservative Heritage Foundation, are urging lawmakers to vote against the bill.
“At that the same time we’re saying as Republicans that we’re going to balance the budget in 10 years, we’re going to add $120 billion, $130 billion to the deficit, and that seems incongruous to me,” Labrador said. “I’m trying to figure out how this is a good deal.”
Senate Democrats blasted the bill for a provision that extends the Children’s Health Insurance Program for only two years. They want it extended for four years.
“How do you help the doctors and then only do children for two years?” said Sen. Sherrod Brown, D-Ohio. “We’re going to do whatever we have to do. I don’t know how you say ‘yes’ to the doctors’ fix, as much as I want to do it, and not say ‘yes’ to children’s health insurance.”
“AARP believes that before asking beneficiaries to pay more for their care, the physician community must be asked to contribute financially to the SGR fix,” Nancy LeaMond, executive vice president of AARP’s State and National Group, wrote in a letter to congressional lawmakers last week.
Pelosi remained upbeat about the bill’s prospects.
“At long last, we will replace the broken SGR formula and transition Medicare from a volume-based system toward one that rewards value, ensures the accuracy of payments and improves the quality of care,” she said.
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