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ACP Statement on Congressí Failure to Stop Medicare Physician Payment Cuts

Downward Trajectory of Congressí Approach Undermines Physician Confidence

May 28, 2010

J. Fred Ralston, Jr., MD, FACP
President, American College of Physicians
Internist, Fayetteville, Tenn

The American College of Physicians (ACP) is deeply disappointed by Congressí recurring failure to pass legislation to stop a devastating 21 percent cut in Medicare and TRICARE payments to physicians. Because of Congressí failure, the cut will go into effect on June 1.

Internists and their patients are rightly angered by the fact that too many of their elected representatives and senators chose to put politics ahead of ensuring that seniors and military families have access to health care.

We acknowledge and appreciate that the House and Senate leadership and President Obama have advocated for legislation to halt the immediate cut and had sought a longer-term approach.

Yet the fact remains that time-and-time again, too many members of Congress from both political parties have refused to support legislation to prevent the cut and provide long-term stability in Medicare.

They have declined to support legislation to move toward a better and more stable payment system, which could have served as the basis for permanent repeal of the unworkable Sustainable Growth Rate (SGR) formula.

They have withheld their support even though they knew that the result will be to further undermine physiciansí and patientsí faith in Medicare and TRICARE.

They withheld their support, even though they knew it would introduce chaos into physician practices. Physicians, once again, are left with trying to keep their doors open for their patients without knowing, from month to month, how much Medicare and TRICARE will reimburse them for their services

In addition, the downward trajectory of Congressí approach to the SGR problem has further undermined physicians confident in Medicare and TRICARE.

  • On November 19, 2009, the House of Representatives passed H.R. 3961, which would have permanently repealed the SGR and replaced it with a better payment framework. This new payment framework would have recognized the importance of providing more realistic spending targets for all physician services, with the opportunity for primary care and preventive services to receive higher updates to address long-standing payment inequities. ACP strongly supported this legislation. It did not advance in the Senate.
  • Two weeks ago, House and Senate leadership were prepared to offer legislation, with ACPís support, to provide stable Medicare updates through 2014. Like H.R. 3961, it too would have begun to move to a new framework in 2012 through 2014, which would have provided for more realistic updates for all physician services, guaranteed that no services would be cut, and created the opportunity for higher updates for primary care and preventive services. This proposal was withdrawn when it became evident that not enough members of Congress would vote for it.
  • Earlier this week, a provision was included in H.R. 4213 that would have provided positive updates through 2013. This new framework would have provided positive updates for the remainder of 2010 and 2011, and would have allowed spending on all physician services in 2012 and 2013 to grow at a higher and more realistic level than under the unworkable SGR, guarantee by law that no payment updates could be reduced, and create an opportunity for under-valued primary care and preventive services to receive more equitable updates. Regrettably, though, this approach was dropped because not enough members of Congress would commit to voting for it.

Yesterday, the House of Representatives and the Senate could have acted on legislation to provide positive updates to physicians only for the next 19 months. This legislation would have averted the immediate cut and provided updates that reflected increases in physiciansí practice costs, but if fell far short of providing longer-term stability and moving toward a better payment framework. Although the House may vote on this proposal today, the fact is that with the Senate having recessed, it is too late to stop the June 1 cut. Even this modest step, which dealt only with the immediate problem, has failed to advance to enactment because too few legislators, particularly in the Senate, were willing to commit to vote for it. Many of the legislators who refused to support legislation to avert the SGR cut and move to a better payment system have cited the deficit. Yet the fact is that Congressí recurring failure to enact a long-term plan to replace the SGR will result in bigger cuts and greater budget outlays in the future.

Now, Medicare increasingly is viewed as an unstable and unreliable payer of services, with the result that more and more physicians will likely have no choice but to limit how many Medicare and TRICARE patients they can afford to accept into their practices.

During the Memorial Day recess, ACP is calling on its members to let their elected members of Congress know that Congressí recurring failure to avert the Medicare physician payment cuts and to move to a more stable system to replace the unworkable SGR simply is unacceptable.


The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 129,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.

David Kinsman, (202) 261-4554
Jacquelyn Blaser, (202) 261-4572

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