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

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Policy briefs

From the October ACP Observer, copyright © 2006 by the American College of Physicians.

ACP advocates for changes in consultation policy

The College is calling for changes in Medicare billing requirements for physician consultations regarding transfer of care.

In an Aug. 14 letter to CMS administrator Mark B. McClellan, FACP, the College asked for two changes to the Medicare Claims Processing Manual 30.6.10:

  • Modify the transfer of care requirements to more closely match the term used by practicing physicians.
  • Allow physicians to bill for consultations for postoperative conditions in addition to billing for preoperative consultations.

“ACP believes that these two changes are great strides in increasing the consistency of the consultation guidelines," wrote Joseph W. Stubbs, FACP, chair of ACP’s Medical Services Committee.

The full text of the letter is online.

ACP President warns of payment cuts in proposed fee schedule

In an Aug. 28 letter, ACP President Lynne M. Kirk, FACP, informed all ACP members of the release of the proposed 2007 Medicare Physician Fee Schedule. The proposed fee schedule would cut physician payments by 5.1% starting on Jan. 1, 2007.

The sustainable growth rate (SGR) formula, which determines Medicare payments to physicians, was created in 1997. This formula ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. This is the sixth year that the formula could potentially cut payments. However, with the exception of 2002, every year Congress has passed legislation that prevented the cuts from going into effect.

Dr. Kirk asked ACP members to contact Congress to ask them to take action to replace the cuts with stable and positive Medicare physician reimbursement updates over both the immediate and long term.

Dr. Kirk went on to discuss changes that the CMS had proposed earlier in the summer that would result in payment increases for internists. She stated that these changes remain extremely beneficial to internists by redistributing approximately $4 billion in Medicare payments to services performed principally by internists and family physicians. However, she also warned, “if the SGR cuts are allowed to go into effect all or most of this initial gain for internists and their patients will be eliminated.”

The full text of Dr. Kirk’s letter is available online.

ACP physicians meet with lawmakers about Medicare cuts

Physician leaders from ACP met with members of Congress on Sept. 12 to describe the negative impact Medicare cuts would have on their practices. In a joint effort with physicians from the American Academy of Family Physicians (AAFP) and the American Osteopathic Association (AOA) they met to discuss the magnified effect these cuts would have on primary care physicians in particular.

“Medicare beneficiaries rely upon their primary care physicians not only for quality health care, but also for access to other parts of the Medicare program,” said C. Anderson Hedberg, MACP, immediate-past president of ACP. “We look forward to working with Congress to maintain access to physician services for the millions of beneficiaries participating in the Medicare program.”

Please visit ACP’s Legislative Action Center for further information on how you can help to avert the potentially devastating effects of the SGR cuts.

ACP president commends working group on health care access

In an Aug. 22 letter to the Citizens’ Health Care Working Group, ACP President Lynne M. Kirk, FACP, praised the group for bringing attention to the issue of access to health care.

In commenting on the group’s report, “Health Care That Works for All Americans,” Dr. Kirk noted similarities with ACP’s own proposal for a step-by-step expansion of health insurance coverage. She said that the two are based on many of the same principles, and that ACP agrees with the Working Group’s conclusion that all Americans should be guaranteed access to affordable health care.

In 2002 ACP developed a proposal for a step-by-step expansion of health care access, “Achieving Affordable Health Insurance Coverage for All within Seven Years: A Proposal from America's Internists.” This paper offered a framework for policies that would enable all Americans to have access to affordable health insurance coverage within seven years.

“ACP commends the Working Group for giving a greater voice to everyday Americans by presenting these thoughtful recommendations on how best to guarantee health care for all,” Dr. Kirk concluded in the letter. “We look forward to working with you to fix our nation’s broken health care system.”

The full text of Dr. Kirk’s letter is online along with ACP’s proposal. The Working Group’s recommendations are online.

Medicare moves to income-based premiums

Medicare premiums for most seniors will increase 5.6% in 2007, but premiums for wealthier beneficiaries will go up even more, CMS announced last month. It is the first time the government has required wealthier people to pay higher premiums.

The standard monthly premium for Medicare Part B will rise from $88.50 to $93.50. Medicare officials said that a modest slowdown in physician spending growth but very rapid growth in spending for hospital outpatient services contributed to the new prices. However, the increase is less than the double-digit increase that officials had predicted earlier.

For individuals with an annual income of more than $80,000, premiums will range from $106 to $162.10 per month. Medicare officials said the change will save $7.7 billion over the next five years and more than $20 billion in the next decade. Officials said they expect 9,000 higher-income people to drop out of the program next year and 30,000 to leave by 2010 as a result of the income-based premium increases.

The program would have required a higher premium increase if not for planned physician payment cuts, Medicare officials said. If Congress had eliminated the payment cut and simply frozen physicians’ Medicare fees in 2007, it would have required a further increase of roughly $1.50 in the monthly premium. ACP has been actively urging Congress to replace the cuts with physician reimbursement updates.

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