Iowa physicians to benefit from GPCI fix in health reform legislation!
March 30, 2010
In a major development that helps ease the geographic disparity in physician Medicare reimbursement, Iowa's Work GPCI will return to 1.0 (from 0.965) and Iowa's PE GPCI will increase from 0.870 to 0.935 as a result of changes in physician Medicare reimbursement contained in the recent health reform legislation passed by Congress. The impact on Iowa physician reimbursement due to the increases in the Work and PE GPCIs is about 5 percent in 2010 - roughly 1.8 percent from the Work GPCI increase and roughly 3.2 percent for the PE GPCI bump. The reconciliation package included $400 million for covering the additional PE bump for all payment localities across the nation.
The legislation passed by Congress included HR 3590, the Patient Protection and Affordable Care Act, and HR 4872, the Health Care and Education Reconciliation Act of 2010. HR 3590 became public law on March 23 and HR 4872 was signed into law by President Obama on March 30. For all of those Medicare Part B payment localities with a Work GPCI floor below 1.0, HR 3590 reinstates the 1.0 floor for 2010 retroactive to January 1.
HR 3590 also included Senator Charles Grassley's Practice Expense (PE) GPCI language, which addressed a 2010 PE GPCI fix of one-fourth to the rent/staff wages inputs and a 2011 PE GPCI fix of one-half to the rent/staff wages inputs. In HR 4872, Congressman Bruce Braley succeeded in amending the 2010 PE GPCI fix to be one-half, the same as in 2011. The 2010 PE GPCI fix is to be retroactive to January 1. HR 3590 gives an additional geographic fix to frontier states (MT, ND, SD, UT and WY) with establishment of a 1.0 floor on the PE GPCI beginning in 2011.
Finally, two studies will be conducted, one by the Institute of Medicine as directed by HHS Secretary Kathleen Sebelius, and the other by CMS as directed by HR 3590. The IOM study will look at all three GPCIs (work, practice expense, and malpractice) as well as the hospital wage index, while the CMS study is to focus on the PE GPCI, with reports of their findings expected in 2011. The findings of the CMS study are to be implemented by January 2012 while the findings of the IOM study are to be implemented by December 2012. IMS will monitor closely the studies and their implementation processes.
IMS physician leaders and members of the Geographic Equity in Medicare (GEM) Coalition are grateful for the efforts on our behalf by Congressman Bruce Braley, Senator Charles Grassley, and Senator Tom Harkin.
Congress fails to postpone or fix SGR cut before their recess
On March 25, the Senate held floor debate on a bill, H.R. 4851, which would extend a number of expiring programs through April. The bill had already passed the House and included a 30-day extension of current Medicare physician payment rates, postponing once again the 21.3 percent cut scheduled to take effect in 2010. It also addressed a number of other programs such as extensions of COBRA benefits and unemployment insurance benefits for Americans who have lost their jobs.
In a replay of the standoff that occurred a month ago, this time it was Senator Tom Coburn (R-OK) who objected to the bill's consideration, on the basis that it should not be considered emergency spending that would be exempt from budgetary offsets. As a result, Congress will adjourn for its two-week spring recess without taking action to stop these programs from expiring. The AMA has been told that the Senate plans to hold a cloture vote after the recess which, if supported by 60 Senators, will allow a vote to occur on the legislation. That vote could occur as early as April 12.
Congress failed to act yet again and, as a result, the 21.3 percent Medicare physician payment cut will take effect on April 1. CMS will be making an announcement shortly about their plans for handling the situation. Judging from past experience, CMS will not be forced to process claims at the reduced payment rates for 10 business days.
This repeated game of brinksmanship is wreaking havoc with physician practices, and is causing both physicians and patients to lose confidence in the Medicare program. It illustrates in stark terms why medicine can no longer support short-term "fixes" to a formula that we knew would not work at the time Congress created it.
IMS urges its members to contact their Representatives and Senators and hold them accountable for their inability to do what they know is right for patients and their physicians. Forty-five million Americans count on Medicare, and physicians simply cannot run viable practices in an environment with such extreme financial uncertainty. Medicine knew when Congress created the sustainable growth rate (SGR) formula that it would not work, and this point has been proven every year for nearly a decade. Congress must stop playing games with physicians and patients and do what they know must be done: Repeal the SGR formula once and for all.
AMA resources to assist in understanding the legislation
The AMA is developing new resource materials for physicians and patients to improve their understanding of health system reform legislation and to help them prepare for its implementation.
One of the new documents available on the AMA's health system reform Web site lays out the timeline for implementation (PDF) of bill provisions. Also available is a continually updated frequently-asked-questions and answers document and a separate document (PDF) which responds to questions the AMA has received on the medical liability reform provisions of H.R. 3590.
The debate on Sunday, March 21
On March 21, the U.S. House passed H.R. 3590, the Patient Protection and Affordable Care Act, as well as the reconciliation bill, H.R. 4872, the Health Care and Education Affordability Reconciliation Act, which contains additional refinements. Together, the two bills are viewed as the most important health care legislation since the creation of the Medicare program.
H.R. 3590 and the related reconciliation bill provides an opportunity to help millions of patients by extending coverage to 32 million Americans, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens and protecting the fundamental principles of the patient-physician relationship.
The health reform legislation approved by the House is an important step but far from the final step in health system reform. The AMA has pledged to work vigorously to pass additional legislation to correct deficiencies in H.R. 3590 and adopt other critical health system reforms. Corrections bills will be introduced to make important policy changes that were not incorporated in the reconciliation package. The House and Senate will take up SGR reform legislation in the next couple months. There still is much work to do to realize many of medicine's priority objectives.
AMA President J. James Rohack, MD, said in a special statement that the AMA remain actively engaged to ensure that before Congress adjourns there are additional important changes to our health system that couldn't be addressed in the reconciliation process, including repeal of the Medicare physician payment formula that threatens access to care for seniors and military families.
"Congress must also move immediately to correct problems with the Independent Payment Advisory Board. The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery. We will be relentless in our pursuit of permanent repeal of the Medicare physician payment formula, corrections to IPAB, medical liability reform and other important actions that we outlined in a letter to Congress," he said.
Dr. Rohack also said that by "extending health coverage to tens of millions of uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and the physicians who care for them. There are increased payments for primary care physicians caring for Medicaid patients and bonus payments for physicians in underserved areas. Those who have insurance will see improvements right away: lifetime caps on coverage end; children can stay on parents' policies until age 26, and insurance companies can't cancel coverage except in the case of fraud."