Friday, December 12, 2014

Same old, same old

The 113th Congress will be wrapping up its two year session within the next few days—and good riddance!  Measured by how many laws it is has passed, this Congress is likely to turn out to be the least productive in modern U.S. history.

Now, some might say that passing laws isn't necessarily a good thing, if it results in bad laws.  The problem, though, is that because this Congress was unable to reach agreement on just about everything and anything, many important issues where legislation is needed were neglected.

Take two of the medical profession’s highest priorities: repeal of the Medicare SGR formula, and continuation of a program that raised Medicaid payments to primary care physicians (and related subspecialists) to no less than the Medicare rates.  Despite the best effort made by ACP, and many others, Congress failed to complete action on either.  This is how I explained the situation in an email I sent yesterday to the 12,000-plus internists who participate in the College’s grassroots ACP Advocates network:

Dear ACP Advocates,

I am writing to thank you for all of the work you have done to help ACP advance its advocacy agenda with the 113th Congress, and to update you on where things stand on two of our highest priorities: (1) reform of the Medicare physician payment system and repeal of the SGR formula, and (2) continuation of the Medicaid primary care pay parity program.  I also write to share with you our current thinking about priorities for the new 114th Congress, which will take office in January.

Historians are likely to label the 113th Congress as perhaps the least productive ever, as it has compiled an unprecedented record of failing to address the key challenges facing our country. Regrettably, improving healthcare will be among the many issues where Congress has failed to act.

Specifically, it is now evident that Congress will, within a few days, adjourn without enacting legislation to repeal the Medicare SGR formula or to reauthorize the Medicaid primary care pay parity program.

This is not the first time that Congress has failed to enact legislation to repeal the Medicare SGR formula, of course, but it is particularly frustrating this time around, because Congress was so close to enacting a bipartisan and bicameral (House and Senate) bill to permanently repeal the SGR and make other improvements in Medicare payment policies. You may recall that both parties had agreed to such a bill earlier this year, but they couldn’t agree on how to pay for it. So, instead, they passed another temporary “patch” to prevent an SGR payment cut that would have gone into effect on April 1—their 17th patch over the past 11 years!  This patch will expire on March 31, 2015, at which time the SGR is scheduled to cut physician payments by another 21 percent.

Even so, despite the patch, ACP did not give up on getting full SGR repeal in the 113th Congress. With your support, ACP has continued to press Congress to enact the bicameral and bipartisan SGR repeal bill in the current post-election “lame duck” session. We now know, though, that they will end the year without doing so, to our great disappointment.

This does not mean, though, that your and our advocacy on SGR repeal has been for naught. Because of our efforts, ACP was able to influence this bipartisan, bicameral SGR repeal bill to include positive payment incentives for physicians who practice in a Patient-Centered Medical Home; to simplify and harmonize Medicare reporting programs (including removing scheduled penalties under those programs); and to make many other improvements. We fully expect that this bill will be the starting point for the new 114th Congress next year, and we will redouble our efforts to get Congress to act upon it before the current patch expires on March 31.

Similarly, this Congress’s failure to reauthorize the Medicaid primary care pay parity program is not the end of the story. Because Congress did not reauthorize this program--which pays internists (including our subspecialists) no less than the Medicare rates for designated services to Medicaid enrollees--most of you will see deep cuts in your Medicaid primary care payments on January 1. ACP will continue its efforts to inform the new 114th Congress of the devastating impact such cuts will have on Medicaid patients’ access to primary care, and to seek to get Medicaid pay parity renewed early in the new Congress. We also will work with our chapters to explore opportunities to get the program funded by the states.

I am sure you are disappointed, even angered, by Congress failing to complete action on these two top ACP priorities, as we are.  Earlier today, ACP issued a public statement expressing “profound” disappointment with Congress’ inaction on the SGR and Medicaid pay parity. But this is not the time for us to throw in the towel.  Next year, ACP’s congressional advocacy agenda will include not only SGR repeal and reauthorization of Medicaid pay parity, but also, reauthorization of the current Medicare 10 percent primary care bonus program, which expires at the end of 2015; reform of Graduate Medical Education financing; medical liability reform; regulatory relief from meaningful use requirements, and much, much more.  You, as a member of our over 12,000-strong ACP Advocate grass roots network, will be critical to our efforts in the new 114th Congress.

Thank you for your efforts and continued support.

Bob Doherty, Senior Vice President, Governmental Affairs and Public Policy

There is not much more that I can say in this space, other than to say how Congress’s inability to agree on policies to improve Medicare and Medicaid payments is simply maddening to me, my colleagues on the ACP advocacy staff, and the ACP leadership, as I expect it is for most readers of this blog.

Yet we remain fully determined to try to move both issues, and other ACP priorities, forward in the new 114th Congress.

Today’s questions: What do you think of the record of the “least productive Congress ever” on healthcare, including the SGR and Medicaid primary care pay parity?  Do you expect things to be better with the new Congress?

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