Clock is winding down on pending Medicare fix

Unless Congress acts during its post-election session, Medicare payments to physicians will be cut by 5.1 percent. Although several lawmakers acknowledged that the Medicare SGR is a flawed payment formula and the cuts should be reversed, no action was taken before Congress adjourned for the November elections.

Lawmakers have returned to their districts to prepare for the elections, so now is the perfect time to contact your representatives and make your voices heard. Eight Texas representatives sit on the two House committees that have jurisdiction over the Medicare payment formula, the House Committee on Ways and Means and the House Committee on Energy and Commerce. Those representatives and their district phone numbers are:

Rep. Sam Johnson (District 3) Ways and Means -- (972) 470-0892
Rep. Ralph Hall (District 4) Energy and Commerce -- (972) 722-0907
Rep. Kevin Brady (District 8) Ways and Means -- (936) 441-5700
Rep. Al Green (District 9) Energy and Commerce -- (713) 383-9234
Rep. Charles Gonzalez (District 20) Energy and Commerce -- (210) 472-6195
Rep. Lloyd Doggett (District 25) Ways and Means -- (512) 916-5921

The other two representatives with the power to stop the cut, Rep. Joe Barton (District 6) and Rep. Michael Burgess (District 26), have already expressed a commitment to reversing the 5.1 percent cut by year’s end and to working on a long-term fix for the SGR as soon as possible. That’s promising news, but if there is to be Congressional action after the elections, their fellow representatives need to hear about the problem today. Consider these facts:

• Since 2001, the inflation rate as measured by the government, the Medicare Economic Index (MEI), has risen 16 percent; Medicare payment rates have not kept pace.
• Continued cuts to the reimbursement rate will lead physicians to consider limiting the number of Medicare patients or even to retire early and leave practice. With an aging America and the prevalence of more chronic conditions, forcing physicians to make these choices is counter-intuitive.
• A recent survey by the American Medical Association shows that 45 percent of physicians plan to restrict the number of new Medicare patients they accept or cease accepting new Medicare patients altogether if the 5.1-percent cut is not reversed.
• The payment rate discourages promising medical students from choosing family medicine, just when the need for them is increasing.
• This current formula is flawed; if left unchecked, it will result in more payment cuts of nearly 40 percent over the next nine years.

For more information on the scheduled cut and to read about what AAFP is doing to stop it, read the AAFP News Now story.

Turning the tables and grading the payers

When asked about third-party payers, most family physicians have a story to tell. Now, AAFP gives you an online soapbox. Through the “AAFP/FPM Survey of Physicians’ Experiences with Third-Party Payers,” AAFP members can grade individual health plans on 11 factors, including their payment rates, claims processing, formularies and others. Feedback from the online survey is collected and compiled to create a giant report card for insurers. Trevor Stone, a private sector advocacy specialist within AAFP’s Department of Private Sector Advocacy, expects to use the data to shape Academy advocacy in the future.

“The results of this will bolster our private sector advocacy efforts both nationally and locally,” he said.

As well as the third-party payer survey, AAFP offers an online complaint form where members can log complaints regarding health plan interactions or view the complaints of other physicians.

Both the idea for the survey and the complaint form came from a 2005 Congress of Delegates resolution. The resolution, No. 304, called for a health plan clearinghouse “for the purpose of collecting data regarding undesirable business practices of health care insurance companies.” AAFP would “use the information to identify trends and to develop effective policy to promote fair payment for physician services.”

A News Now story on the survey included a piece of commentary from Family Practice Management’s Editor in Chief Robert Edsall. In his October “From the Editor,” Edsall wrote about what benefits the survey will give members.

“Health plans wield considerable power in the current health care system -- power disproportionate to the value they add,” he said. “And for a long time, they have seemed to hold all the cards, handling contract ‘negotiations’ with most practices as take-it-or-leave-it affairs.

“You may not be as powerless against them as you feel,” Edsall continued. “If knowledge is indeed power, we hope that the results of the (survey) will give you a bit more power.”

A call for an insurance company “report card” came out of a February meeting of TAFP’s Commission on Managed Care and Health Care services during the Academy’s most recent Interim Session. Shortly after that meeting, TAFP staff became aware of AAFP’s plans and began working with the national Academy on the project.

You can access the survey on the AAFP Web site. Be sure to have your member ID and password ready. For more information, check out an article on the topic from Family Practice Management.

Perry signs executive order on transparency, HIT

Gov. Rick Perry signed an executive order on Oct. 9 to create a public-private collaborative that seeks to promote health care transparency, support health information technology and encourage a competitive small-employer health insurance market, according to a release from the Office of the Governor. Tentatively named the Texas Health Care System Integrity Authority, the collaborative will consist of 11 members representing different aspects of health care: employers, physicians, hospitals, health plans, pharmacies, clinical laboratories, pharmacy benefit managers and consumers.

“Ultimately, our goal is to improve patient safety and provide consumers with better care at a price more Texas families and small businesses can afford,” Perry said in the press release.

Perry’s executive order closely follows the August executive order signed by Pres. George W. Bush. In the presidential order, Bush directed all federal agencies that administer health insurance programs to increase transparency in quality and pricing, encourage the adoption of health information technology and promote quality-evaluating measures.

THCSIA will report its findings to legislators by March 1, 2007. Read executive order RP61 and the full press release from the Web site of the Office of the Governor.

DSHS advises influenza preparedness

As his parting words from the Texas Department of State Health Services, Texas Commissioner Eduardo Sanchez, M.D., advised Texans to “get a flu shot.” The second Vaccine Advisory, released in October by DSHS, addresses the 2006-2007 Influenza Season and recommends that at-risk groups, including children age 6 months through 4 years, people 50 years or older, residents of long-term care facilities, pregnant women and those with chronic diseases get vaccinated as early as possible in October and November. The flu season typically spans October through March and flu vaccinations take two weeks to become fully effective.

The advisory identifies the flu as a viral respiratory illness with recognizable symptoms such as “a sudden, often high, fever; headache; extreme tiredness; dry cough; sore throat; runny or stuffy nose; and muscle aches.” The flu can be spread through the air, released by a cough or a sneeze, and can lead to more serious complications: bacterial pneumonia, ear and sinus infections, dehydration and worsening of chronic conditions such as congestive heart failure, asthma or diabetes, the advisory stated.

The CDC and influenza vaccine manufacturers expect to produce more than 100 million doses of the vaccine this flu season, distributing 19 million more doses than last year. Providers who ordered the vaccine can expect to receive first shipments by the end of October.

Family physicians are reporting that once again this year, drug stores and grocery stores are receiving bulk orders of flu vaccine before health care providers have received their orders. TAFP and AAFP are paying close attention to this problem. An Oct. 13 letter from the Centers for Disease Control and Prevention says, “ Phased vaccine production and distribution also means that many providers will not see their entire vaccine order until the end of November.” For more information on this developing issue, read the AAFP News Now story.

Also read the Centers for Disease Control and Prevention Influenza recommendations on the CDC Web site, provider information from the Texas DSHS Web site or a PDF of the 2006-2007 Influenza Vaccination Pocket Information Guide for more information on the influenza vaccine.

Vote early, vote often

The 2006 general election is right around the corner. Avoid the long lines at the ballot box by voting early, starting Oct. 23 and ending Nov. 3. Be sure to check the list of TAFPPAC endorsed candidates at www.tafppac.org before you head out to the polls. Additional voting information can be found on the Texas Secretary of State’s Web site.

Encourage youth to be tobacco-free

The Texas Tar Wars program needs volunteers to present one-hour lessons about the importance of staying tobacco-free to forth- and fifth-grade students. Any community leader, especially health care professionals, can sign up to be a presenter. Tar Wars is an initiative of the American Academy of Family Physicians and supports tobacco-free lifestyles through in-classroom presentations and an annual poster contest.

There is no cost to participate and presenters can donate as much or as little time as they have available. A Tar Wars program guide contains a set curriculum that presenters can follow in the classroom, making pre-preparation minimal.

Be a role model to kids in your community and sign up to be Tar Wars presenter. Contact Camille Fajardo, Tar Wars coordinator, with any questions or visit the Tar Wars section of the TAFP Web site.

Doctors in Motion update

CME topics for the 2007 TAFP Doctors in Motion Winter Symposium Jan. 12-17, 2007 have been posted on the education page of the TAFP Web site. Visit the site to view the topics as well as for more information on lift ticket and equipment discounts. Be sure to register before the early bird deadline on Dec. 11, 2006 for a reduced rate.

Copyright 2006, Texas Academy of Family Physicians