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David A. Fleming, MD, MA, MACP
President of the American College of Physicians (ACP)
December 11, 2014
(Washington) - 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
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. 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, the American College of Physicians
did not give up on getting full SGR repeal in the 113th Congress,
as it continues 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 profound disappointment.
This must not spell the end, though, of the effort made
by so many members of Congress and their staff members, with the
support of ACP and many others, to reach agreement on policies to
replace the SGR. The bipartisan, bicameral SGR repeal bill
agreed to earlier this year included several ACP priorities in
addition to SGR repeal: creating positive payment incentives for
physicians who practice in Patient-Centered Medical Homes;
simplifying and harmonizing Medicare reporting programs (including
removing scheduled penalties under those programs); and many other
improvements. We fully expect that this bill will be considered by
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
Similarly, Congress's failure to reauthorize the current
Medicaid primary care pay parity program- which pays
primary care physicians and internal medicine and pediatric
subspecialists no less than the Medicare rates for designated
services to Medicaid enrollees-must not be the end of the
story. Because Congress did not reauthorize this program,
most physicians in the currently eligible specialties will see deep
cuts in their Medicaid primary care payments on January 1. ACP will
continue its efforts to inform the new 114h Congress of the
devastating impact such cuts will have on Medicaid patients' access
to primary care, and to seek to get the Medicaid pay parity program
renewed early in the new Congress.
It is regrettable that the 113th Congress is adjourning without
completing action on critically important legislation to reform
Medicare physician payments and ensure that Medicaid patients will
continue to have access to primary care physicians. The new 114th
Congress can, and must, do better.
The American College of Physicians is the
largest medical specialty organization and the second-largest
physician group in the United States. ACP members include 141,000
internal medicine physicians (internists), related subspecialists,
and medical students. Internal medicine physicians are specialists
who apply scientific knowledge and clinical expertise to the
diagnosis, treatment, and compassionate care of adults across the
spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
David Kinsman, (202) 261-4554, firstname.lastname@example.org