Letter describes two issues that must be considered during lame-duck session to ensure high-quality, accessible and affordable care for patients enrolled in Medicare and Medicaid
November 20, 2014
(Washington) - It is critical that Congress consider two issues in this post-election lame-duck session The American College of Physicians (ACP) today told Senators Reid and McConnell and Representatives Boehner and Pelosi. A three-page letter from David A. Fleming, MD, MA, MACP, president of ACP emphasized the importance of enactment of the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014" (H.R. 4015/S. 2000), and continuation of the Medicaid Primary Care Pay Parity program, which is set to expire on Jan. 1, 2015.
"It is time for this Congress to put an end to the endless debate over the SGR and fix a broken physician payment system," Dr. Fleming declared , "by enacting the 'SGR Repeal and Medicare Provider Payment Modernization Act of 2014' in the lame-duck session."
Dr. Fleming also pointed out that "by repealing the SGR, this legislation removes the single greatest roadblock to achieving real payment reform. But it does much more than this: it creates powerful incentives for physicians to adopt innovative payment and delivery models, like Patient-Centered Medical Homes, to improve the quality, accessibility, and cost-effectiveness of patient care."
This bill, which was the product of months of hearings, consideration and debate, has been endorsed by more than 600 physician organizations, including ACP, by the chairs and ranking members of the Senate Finance, House Ways and Means, and Energy and Commerce Committees, by physician members of Congress, and by many other patient, health care provider, and business advocacy groups.
"Unlike past legislative years, Congress is at a juncture today where it has finally achieved bipartisan, bicameral consensus on legislation to achieve these essential goals," Dr. Fleming emphasized.
"It is also critically important that Congress reauthorize what is often referred to as the Medicaid Primary Care Pay Parity Program, as proposed in the Ensuring Access to Primary Care for Women & Children Act, H.R. 5723 and S. 2694," Dr. Fleming noted. "The Medicaid Primary Care Pay Parity program ensures that physicians practicing in designated primary care specialties and related subspecialties continue to receive Medicare-level reimbursement rates for providing primary care and immunization services to patients enrolled in Medicaid. Well-established research has shown that low Medicaid payment, which in many states has historically been well below the costs of delivering care, has been a major reason physicians are reluctant to participate in the program."
Finally, on the pay-parity issue, Dr. Fleming said, "Maintaining access to primary care and related medical and pediatric subspecialists, by ensuring comparable rates under Medicare and Medicaid for these services, is especially critical at a time when the population enrolled in Medicaid is surging. These comparable Medicaid payments serve as incentives for eligible physicians to maintain or increase their Medicaid patient population in all states, whether or not a given state has elected to expand its Medicaid program. A recent survey of a representative sample of ACP members found that almost half of those participating in the current Medicaid Primary Care Pay Parity Program would have to reduce the number of Medicaid patients they see, or drop out of the program altogether, if the program is allowed to expire at the end of this year."
Dr. Fleming concluded the letter to Congressional leadership by repeating ACP's asks:
- Complete action in the lame-duck session on the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014"
- Reauthorize the Medicaid Primary Care Pay Parity Program for at least two additional years beyond 2014.
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.Contact: