American College of Physicians: Internal Medicine — Doctors for Adults ®

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ACP calls for changes in Medicare reform legislation

The College has pressed for increased physician pay and argued against a proposal for mandatory e-prescribing

From the October ACP Observer, copyright 2003 by the American College of Physicians.

As leaders of the Senate and House worked during late summer to reconcile different Medicare reform bills, ACP continued to press Congressional leaders for changes on key issues that included physician reimbursement, a new way to calculate Medicare drug payments to physicians and a plan to require all physicians to start using electronic prescribing technology.

The two bills that are being discussed would establish a $400 billion prescription drug benefit for Medicare beneficiaries. Both pieces of legislation, however, could have a substantial impact on what physicians are paid and how medical practices do business in the coming years.

Here is an overview of the issues the College has addressed:

  • Physician reimbursement. The Senate and House bills diverge on the issue of physician reimbursement. The Senate version would allow a 4.2% cut to take effect in January, with another pay cut scheduled for 2005. The House version calls for increases of at least 1.5% in both years.

    Throughout the summer, ACP warned Congressional leaders that any cuts in physician reimbursement would result in a widening access problem for Medicare beneficiaries. (College letters and statements on proposed pay cuts are online.)

    In late summer, the College urged ACP members to contact their elected officials to ask for final language that would safeguard physician reimbursement. To make your voice heard, go to ACP's Legislative Action Center.

    You'll find background information on the legislation, as well as a letter you can e-mail or fax to your member of Congress. (You can send the letter as is or personalize it.)

  • Medicare drug payments. ACP has called on Congress to make sure that any changes in Medicare drug reimbursement don't unfairly reduce legitimate payments to physicians for their drug acquisition and overhead costs.

    In a Sept. 5 letter to members of the conference committee working to reconcile the House and Senate bills, the College joined 16 other national medical organizations in urging that Medicare payments for physician-administered drugs, such as chemotherapy drugs provided in a doctor's office, fully cover the physician's cost of buying and administering the drug.

    ACP pointed out that while Medicare reimbursement for drugs may exceed physicians' actual costs, that margin varies by practice size, location and drug. An across-the-board cut in drug reimbursements, College officials warned, could be financially disastrous for practices that already face a low margin.

    The College also pointed out that if legislators are going to cut Medicare payments for drugs, they must increase reimbursements for administering drugs and pay for physicians' costs of storing and preparing drugs.

    ACP's letter also said that any improvements in drug payments should not trigger pay cuts for other services. The letter is online.

  • Electronic prescribing. The College is asking Congress to reject a requirement in the House bill that would force physicians to start writing and sending prescriptions electronically in three years.

    In an Aug. 15 letter to members of the conference committee, the College said it supports electronic prescribing and the role it can play in reducing errors and cutting administrative costs. But the letter pointed out that electronic prescribing technology is in its infancy and remains largely unproven.

    The House Medicare reform bill requires all Medicare prescriptions to be written and transmitted electronically within three years. ACP likened that provision to "force feeding" unproven technologies on both physicians and patients.

    To guide Congress' efforts, the College sent legislators a list of seven principles designed to provide a smooth transition to electronic prescribing.

    In part, the principles called on the federal government to do the following: involve physicians in designing e-prescribing technologies; pilot-test standards before implementing them; refrain from giving physicians an unfunded mandate to introduce e-prescribing into their practices; and refrain from using e-prescribing standards to dictate how physicians practice medicine through overly restrictive practice guidelines or drug formularies.

    The Senate version of the Medicare reform bill calls for e-prescribing standards to be used by physicians who voluntarily incorporate electronic prescribing into their practices. The College urged legislators to make several changes to that bill, including delaying the implementation of those standards to Jan. 1, 2008, to allow sufficient time to conduct demonstration projects.

    ACP's letter and the list of principles are online.

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