Legislators Urge Administrative
Changes to Medicare Physician Payment Formula
May 28, 2004 - Seventy-two
(PDF, 1 page - 6KB) Senators and 240
(PDF, 1 page - 16KB) Representatives signed letters
May 25 and May 21, respectively, urging Centers for Medicare
and Medicaid Services (CMS) Administrator Mark McClellan,
M.D., to make a variety of adjustments to the sustainable
growth rate (SGR) methodology under the Medicare physician
fee schedule.
Spearheaded by Reps. Phil Crane (R-Ill.) and Sherrod Brown
(D-Ohio), and Sens. Jon Kyl (R-Ariz.) and Blanche Lincoln
(D-Ark.), the letters recommend "policy adjustments the
Administration could make that would lead to more accurate
calculations of the targets used in physician reimbursement."
Specifically, the letters encourage removal from the sustainable
growth rate formula of the cost of physician-administered
drugs. The letters suggest that the formula does not adequately
capture the full impact of changes in laws, regulations, and
new screening benefits as required by the Medicare law, as
well as CMS coverage decisions
In light of the upcoming cuts to the Medicare physician fee
schedule beginning in 2006, the letters acknowledge "such
fine-tuning will not eliminate all of the problems in the
current SGR formula," but that "it will help facilitate
Congress' efforts to develop a more reliable reimbursement
system."
"Any actions the administration can take to more accurately
account for the realities of spending on physician/practitioner
services under the SGR formula, both as to actual spending
and target spending, will facilitate Congress' efforts and
to better ensure continued patient access to high quality
care."
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
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