DJP Update 6-16-2010 More on AMA Annual Meeting policy directing new Medicare Payment Option and drafting of legislation; Membership; Lagniappe
DJP Comment: Great new policy. I gave you the exact wording in the DJP Update 6-14-2010. See http://www.intrepidresources.com/html/djp_update/6-14-2010.html
Lots of great homework and advocacy done by many doctors getting this passed. Too many to name but the Coalition of State Medical & National Specialty Societies had this item as one of its critical goals to get passed. Dr. Bob Sewell, Dr. Van Culotta, Dr. Todd Williamson, Dr. Mike Green, and Dr. Stormy Johnson are just a few of those who pushed this over the finish line. Thanks for the overwhelming vote of support from the House of Delegates in the offered amendment to the reference committee’s substitute resolution. And key help from staff of state and specialties. A team effort!
Now it needs to be implemented. And the word needs to go out to patients and Congress.
AMA leadership now says it will enhance communication with the physicians and one can hope that there will be aggressive advocacy for a policy that will give Congress financial certainty, restore liberty to patients and physicians, and keep physicians in practice. The current SGR flawed formula is a perfect example of the predicted end result of price-fixing. And the treatment of this issue by Congress is disgraceful. In the end, patients will suffer.
Here is the June 16, 2010 issue of “AMA/FEDERATION NEWS: National headlines, grassroots news and important AMA announcements for Federation executives and communicators.”
*** Special AMA Annual Meeting issue ***
1. Physicians use white coats to urge action from Congress on SGR
2. President Obama calls on Congress to act quickly to stop Medicare cut, recommits to permanent payment reform
3. 2010 Annual Meeting highlights
4. AMA adopts new policies at Annual Meeting
5. New leaders elected by AMA
6. New AMA health insurer report card finds need for more accuracy
4. AMA adopts new policies at Annual Meeting
At its Annual Meeting this week, the AMA House of Delegates (HOD) set new policy to immediately formulate legislation for a new Medicare payment option. It would allow patients and physicians to freely contract for payments that differ from the Medicare schedule, while allowing patients to use their Medicare benefits.
At the AMA Website under press releases:
AMA Adopts New Policies During Final Day of Annual Meeting
For immediate release:
June 15, 2010
CHICAGO – The American Medical Association (AMA), the nation’s largest physician group, voted today at its Annual Meeting to adopt the following new scientific policies.
Assuring Patient Access to Physicians Under Medicare In the wake of a Medicare meltdown caused by a 21 percent Medicare physician payment cut, the AMA voted to immediately formulate legislation for a new Medicare payment option. It would allow patients and physicians to freely contract for payments that differ from the Medicare schedule, while allowing patients to use their Medicare benefits.
“Seniors deserve a Medicare benefit that allows them access to and choice of physicians.” said David O. Barbe, M.D., AMA trustee. “Low Medicare payments, continued payment uncertainty, and a steep 21 percent payment cut have put access and choice in jeopardy. A new patient-centered category of Medicare payment will allow seniors to use their Medicare benefit fully for the health care they need.”
DJP Comment: And unfortunately, only one press article about the formulation of balance billing legislation. What happened to all of the newspapers that use to cover all of the AMA Meetings? Thanks, Medpage Now, for this article!
AMA: Delegates Adopt Balance Billing Resolution
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: June 15, 2010
CHICAGO — The American Medical Association’s House of Delegates has adopted a resolution directing the doctors’ group to draft legislation that would allow physicians to bill their Medicare patients for the amount of the claim that Medicare didn’t cover.
The practice — known as balance billing — is one that AMA members have long pushed for. But the resolution passed Monday evening by the House of Delegates is the first to ask the organization to create a new category of payment that would allow for both private contracting and balance billing, according to an AMA spokesperson.
The Centers for Medicare and Medicaid Services (CMS) sets balance billing limits for physicians who treat Medicare patients.
Physicians who do not “participate” in Medicare can still see Medicare patients and can bill them up to 115% of the allowed Medicare fee schedule amount. However, the allowed fee schedule amount for nonparticipators is 5% less than it is for doctors who are classified as “participating.”
“Participating” doctors get paid the full Medicare fee schedule amount, although that’s notoriously lower than private insurance reimbursements, but are not allowed to bill patients for the amount Medicare doesn’t cover.
Couple that lower reimbursement with the constant threat of major cuts — such as the one looming now that would slash payments by 21% — and many doctors are fed up with Medicare.
That frustration was the impetus for the resolution passed Monday evening by the House of Delegates.
The original report on balance billing from the AMA’s legislative reference committee would have directed the AMA to study alternative payment systems for Medicare and other federal health programs. However, two-thirds of delegates voted to replace that language with a resolution directing AMA to formulate a bill.
“It seems to me, having been around for a long time, we’re at a moment of truth,” said former AMA president Daniel Johnson, a diagnostic radiologist from Metairie, La. “What’s proposed here is a solution for both the government and the doctor.”
The amendment directs the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to fully contract, without penalty to either party, for a fee that differs from the Medicare payment schedule in a manner that does not forfeit benefits otherwise available to the patients.”
The AMA has to draft the bill and present it to members by Sept. 30.
“This is really just reaffirming what is already AMA policy, but adding some action to it, and action is what we need,” said alternate delegate Peter Lavine, MD, an orthopedic surgeon in Washington.
The AMA has several policy statements on the books regarding balance billing. They generally affirm the “free choice” of patients and physicians, and voice AMA support for pursuing a “legislative and legal means” to allow for patients to contract for medical services and for physicians to treat Medicare patients “outside current regulatory constraints.”
Delegate Tom Price, MD, an orthopedic surgeon in Georgia and a Republican congressman, has introduced a bill in Congress that would remove the 115% limit on what nonparticipating physicians can charge their Medicare patients, but the bill has yet to move out of committee.
Although most of the delegates who took the microphone during the debate on balance billing supported AMA pressure on Congress, several delegates warned that it would make the association look bad.
“This is going to make us look stupid. This is going to make us look greedy,” said delegate Lynn Parry, MD, a Denver neurologist.
At least Bruce Japsen of the Chicago Tribune also was there and I did see another reporter from Modern Healthcare. Here is an interview with President-elect Dr. Peter Carmel.
New AMA leader: Doctors will demand more
Published on June 16, 2010 8:16 AM | Submit a comment
By Bruce Japsen | The new president-elect of the American Medical Association promises to lead the nation’s largest doctor group in a more demanding and confrontational relationship with members of Congress.
“The AMA is going to be more insistent and a little edgier with its relationships with Congress and the administration in demanding some of the things we doctors need,” Dr. Peter Carmel, who won a hotly contested election earlier this week to become the AMA’s president-elect, said in an interview with the Tribune.
Carmel, a 73-year-old pediatric neurosurgeon from Newark, N.J., has been on the AMA’s board of trustees for the last eight years and will serve as president-elect until next June. He will then become president, and a year later will serve as the “immediate past president” until June 2013.
In a rare three-doctor race for president-elect, he beat out two members of the 21-member AMA board of trustees that are primary care doctors: a Massachusettsobstetrician and an Indiana family doctor.
Doctors are outraged that Congress failed to avert a 21-percent cut in payments to doctors from the Medicare health insurance program for the elderly that physicians will begin experiencing this week. The cut, which has been delayed many times by Congress in recent years, took effect June 1, meaning doctor checks from claims they submitted for Medicare payment claims will be lower starting this week.
Carmel said members of Congress can expect more hard-hitting attacks from the AMA such as the recent full-page advertisements the doctors group placed in several newspapers that criticized U.S. Senators for leaving Washington for their Memorial Day recess before fixing the payment cut.
“They tell me that (Democratic Senate Majority leader) Harry Reid is infuriated with the ad and I hope so,” Carmel said. “If I had a way of infuriating his Republican counterpart (Senate minority leader) Mitch McConnell, I would do that, too.”
Obama was critical of Republicans in the Senate as well, making the Medicare fee cut a key part of his presidential radio address this past weekend.
In Carmel, the AMA elected a leader with academic and clinical expertise. Carmel is a noted neurosurgeon who maintains an active pediatric neurosurgery practice in Newark, N.J. He is also department chair at the New Jersey Medical School, which has the only neurological surgery residency program in New Jersey.
He comes from a family of physicians that includes his wife, a radiologist, and a son who is a pediatric neurologist. His father was a family practice physician and his daughter-in-law is an internist.
Some AMA observers and doctors at this week’s meeting at the Hyatt Regency Chicago say Carmel won the rare three-doctor race because he was the most critical of the health reform law than the other candidates. In addition, many AMA members feel the health care reform law favors primary-care doctors over specialists and he understands that.
As one example, the Medicaid program for the poor will raise reimbursement rates for primary-care doctors and largely leave specialists’ rates unchanged though they vary from state to state. In addition, specialist doctors who tend to pay higher malpractice premiums were upset that health care reform did not cap malpractice awards.
But AMA board chairman Dr. Ardis Hoven said all three of the candidates for president-elect are collegial and view the health care reform law as a success and a “first step in” reforming the U.S. health system.”
“It’s not primary care versus everybody else, but the need for all physicians to get paid for what they do,” said Hoven, an infectious disease specialist fromLexington, Ky. “There are going to be multiple opportunities going forward to change and modify this law.”
Despite Carmel’s criticism of Congress, he said the AMA and its member doctors are happy the law will expand health benefits to more than 30 million uninsured Americans and eliminate hurdles to coverage such as a health plan’s ability to deny care to patients with pre-existing medical conditions.
“Doctors are pretty much pleased with the gains for patients that are in the health-care law,” Carmel added. “There is some great stuff in there. But we didn’t get our doctor issues at all solved.”
DJP Comment: Finally, great advocacy by Dr. Jeff Terry, Chair of Alabama Delegation to AMA concerning the need to tell the physicians what is the current AMA membership numbers. He was terrific at the microphone and his homework and advocacy were a major factor in getting this amendment passed when Reference Committee F reports were debated:
That our AMA immediately release to each state medical society and specialty society at their request the names, category and demographics of all AMA members of that state or specialty society.
DJP Comment: Obviously, any member of AMA should be able to know on any day what the membership is as of that day. With modern computer systems and databases, there is no excuse for delays such as: “the final numbers are not in for the year, etc.” I made that point in the DJP Update 6-10-2010:
Transparency, accountability, and advocacy are essential to save and enhance AMA membership. And remember, it does not help the situation to attack the messenger of bad news or the questioner who is trying to help. Always remember Hans Christian Andersen’s story, “The Emperor’s New Clothes”.
Lagniappe: Nice to see Congressional candidate Dr. Ron Kirkland of Tennessee participating in AMA meeting. His Website is: http://votekirkland.com/
Check it out.
Looks like we will have to get more doctors in Congress to fix the mess there and help Dr. Tom Price who also participated in AMA House of Delegates.
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