American Society of Hematology

Physician Payment Back in Congressional Spotlight

Published on: June 15, 2011

On June 15, the Medicare Payment Advisory Commission (MedPAC) released its customary June report advising Congress on adjustments to Medicare provider payments. Members of Congress look to MedPAC to provide advice on how to find savings within Medicare to pay for provider payment changes as it faces the looming Medicare physician payment reductions scheduled for 2012.

Meanwhile, the Congressional Budget Office (CBO) has issued a report detailing cost estimates for a range of different approaches to heading off a 29 percent cut in Medicare payments to physicians scheduled to take effect January 1. The 10-year cost of the various payment options range from $22 billion to freeze payments next year at current levels and then revert to a projected 34 percent cut in 2013 to $388 billion to increase payments two percent each year from 2012 to 2021. The CBO regularly produces a compendium of options for lawmakers to consider for altering federal spending and revenues and Congress frequently refers to CBO options when considering changes in spending or revenue.

Congress must pass legislation by December 31, 2011 to avert a scheduled physician payment cut of 29 percent caused by the Sustainable Growth Rate (SGR).

The CBO report follows the start of a series of congressional hearings in May to address the SGR. Prior to the start of congressional hearings, ASH submitted comments to the House Energy and Commerce Committee expressing concern that continual threats of reductions to the conversion factor need to be eliminated and recommended that Congress take the following steps: 

  • Establish a predictable and stable system for updating fees over time to fully and realistically account for the costs of operating a medical practice.
  • Address the imbalance in payments for cognitive services compared to procedural services.
  • Recognize specialty expertise under the fee schedule and value appropriately.

ASH continues to advocate that Congress repeal the current physician payment formula and provide physicians with adequate payment. The Society will keep members apprised of future congressional action and its related advocacy efforts on this issue.

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