AMA physicians gather not just to listen, but to act

If you wanted to be where news was being made in Washington in February, the place to be was the AMA National Advocacy Conference.

It was at the National Advocacy Conference that Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, made headlines when she announced that, in response to AMA advocacy, the agency will re-examine the pace at which the ICD-10 code set is being implemented. Specifically, she said the agency has heard physicians’ concerns about implementing this new code set, understands physicians’ administrative burdens and wants to improve the process for them.

It was also at the National Advocacy Conference that we heard confirmation that the conference committee debating the extension to payroll tax cuts was also considering ways to eliminate the sustainable growth rate formula permanently. Ultimately, the committee opted for another 10-month patch, and current Medicare payment rates were extended through the end of the year. Since Congress once more failed to eliminate SGR, we will be back in the same hot water in December.

Because the annual National Advocacy Conference is a gathering of leaders in the medical profession, it also has become a destination for members of Congress, HHS officials and capital insiders to stop by. Tavenner was only one of several of Washington’s key players who addressed the conference. Others included Reps. Allyson Schwartz (D, Pa.), Phil Roe, MD (R, Tenn.) and Sen. John Kyl (R, Ariz.).

The conference also played host to many nonelected government officials and thought leaders from the physician and broader medical community.

Prominent media were on our agenda, including David Gergen, senior political analyst for CNN; Major Garrett, congressional correspondent with the National Journal, and Mark Halperin, editor-at-large and senior political analyst for }Time magazine. Juan Williams of Fox News was featured at an AMPAC event, and CBS News Chief Washington Correspondent Bob Schieffer hosted the Nathan Davis Awards dinner program.

It was important for us to hear from the Washington people. But they came to the National Advocacy Conference because they also wanted to hear from America’s medical leaders.

They know that while Congress has accomplished little this year, the AMA has made substantial progress in making things happen in Washington that did not require congressional involvement.

Examples of AMA victories include securing additional exemptions to Medicare’s e-prescribing program, a streamlined process for rectifying physician identity theft, and a 90-day grace period for using Health Insurance Portability and Accountability Act version 5010 electronic transactions. Also in 2011, CMS adopted nearly all of the AMA’s recommended changes in the final rule on Medicare accountable care organizations.

Due to the determined efforts of the AMA and state and specialty societies, Washington has seen that physicians can be a powerful force in addressing the future of medicine.

These successes are not enough, of course. While the House and Senate conference committee reached agreement on averting a 27% Medicare physician payment cut on March 1, it missed the opportunity to replace the flawed SGR formula permanently and protect access to care for military families and seniors.

People outside Washington question the logic of spending around $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about an additional $25 billion.

Especially since there is a way to effectively put an end to SGR.

The federal budget includes a reserve of discretionary funding known as Overseas Contingency Operations, or OCO funding. And even though the U.S. recently withdrew all troops from Iraq and has begun winding down operations in Afghanistan, rules governing Congressional Budget Office spending projections assume that OCO will be funded at present levels for the next decade. This means that future estimates of OCO spending are artificially high.

At the same time, CBO budget projections include enormous Medicare physician payment cuts that Congress repeatedly has shown it will not allow to occur. Neither the OCO nor the Medicare payment cut projections reflect reality. Artificially high levels of projected OCO spending can be used to offset unrealistically low estimates of future Medicare physician payments, and the result will be elimination of the accumulated SGR deficit and a far more accurate federal budget forecast.

At the National Advocacy Conference, Kyl told us that his fellow Senate conferees were in agreement about using the excess in projected OCO spending to offset the costs of erasing the SGR debt. Schwartz told us that House Democrats support the use of the OCO offset, and Dr. Roe told us that the majority of the GOP Doctors Caucus were prepared to support it as well.

We appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem. Unfortunately, that position is not yet universal. At issue is the reluctance of some legislators to use the OCO offset and disagreements over what other budget offsets were appropriate or untouchable. These issues have nothing to do with America’s physicians or our patients who rely on Medicare and Tricare.

Many of the physicians who attended the National Advocacy Conference carried this message to their own elected representatives while they were in Washington.

At the conference, legislators from both sides of the aisle encouraged us to continue fighting to abolish SGR so we can ensure that Medicare patients have access to their doctors. With that in mind, we will be assembling a task force with state and specialty societies to firm up a strategy for the next 10 months.

Because shortly after the coming elections, access to care for seniors and military will again be threatened by an even larger cut, and members of Congress will need to take swift action to end the broken formula.