RUOkie

10+ Year Member
7+ Year Member
Mar 3, 2009
760
52
171
Status
Attending Physician
Guys/gals:

Everyone on this forum needs to contact their US Reps and Senators this week to encourage them to repeal the SGF!

http://www.votervoice.net/Files/AAPMR/Images/vvbanner0607.jpg


AAPM&R ACTION ALERT




Tell Congress to Repeal the Flawed Sustainable Growth Rate (SGR) Formula

The American Academy of Physical Medicine & Rehabilitation asks you to email or write to your members of Congress today and urge them to repeal the SGR. If you haven't weighed in yet on the debate occurring in Congress about what to do about Medicare physician payments, you need to do so now, before the decision is made for you.

Background:

On March 25, Congress adjourned for a two-week spring recess without passing a bill that would repeal the SGR. Therefore, the Academy asks that you contact your 2 U.S. Senators or their staff and your U.S. Representative or his or her staff in their District Offices now and ask them to repeal the SGR, the flawed formula for calculating Medicare physician payments.

Currently, a 21.3 percent cut to the Medicare conversion factor mandated by the Sustainable Growth Rate (SGR) formula has been replaced with a freeze (a zero percent update) that expires on March 31, 2010. However, this is only a temporary fix.

The Academy's position is that Congress should repeal the SGR. This is critically important and would lay the foundation for Congress to establish a new Medicare physician payment update system that guarantees access to quality care for seniors and people with disabilities.

PLEASE ACT NOW - Contact Your Members of Congress

For Emails and Letters

Click on the link at bottom of this page to email your two U.S. Senators and your U.S. Representative. Please personalize the attached letter with a few details of your practice and any relevant facilities with which you are affiliated and describe how your patients and your practice could be affected if the SGR is not repealed. Cut and paste your message into an email to your legislators. Congressional staffers prefer emails but if you would like to fax a letter, choose the fax option instead of email, before sending your message.

Be sure to ask them to repeal the SGR for the following reasons:

1. Physicians face a payment cut of over 21 percent on April 1, 2010, a cut that will compromise access to care for Medicare patients and for military families - both active and retired - rely on a stable Medicare payment system to keep their insurance, TRICARE, stable.

2. Seniors grow more concerned about losing access to the physician of their choice - a problem that will only grow as Baby Boomers start to enter the Medicare system.

3. Resolving the problem now is the fiscally responsible course to take. Relying on past methods of postponing the immediate crisis will only increase the cost of a permanent repeal. Congress can no longer afford to kick the can down the road.

Thank you!

WE URGENTLY NEED YOU TO CONTACT YOUR MEMBERS OF CONGRESS NOW!







Click the link below to log in and send your message:
http://www.votervoice.net/link/target/aapmr/FfP7zGW6.aspx <http://www.votervoice.net/link/target/aapmr/FfP7zGW6.aspx>
 
Last edited:

lobelsteve

SDN Lifetime Donor
Lifetime Donor
10+ Year Member
May 30, 2005
13,266
3,207
281
Canton GA
www.stevenlobel.com
Status
Attending Physician
Typical PMR stuff, a dollar short and a day late.

Join the AAPS, suing the government for the Obamacare package. Abandon the AMA, and abandon any organized body that supported the reform package they just voted in.
 

RUOkie

10+ Year Member
7+ Year Member
Mar 3, 2009
760
52
171
Status
Attending Physician
Typical PMR stuff, a dollar short and a day late.

Join the AAPS, suing the government for the Obamacare package. Abandon the AMA, and abandon any organized body that supported the reform package they just voted in.
I have not been a member of the AMA since Sunbeam. I agree with you 100%.

Steve, This is not Obamacare. It is Bushcare. The SGR is 6 years old, or have you not been paying attention. Neither the Republicans nor the Democrats give a **** about physicians.

At least I know my Senators do.
 

SSdoc33

10+ Year Member
Apr 23, 2007
5,965
1,456
281
Status
Attending Physician
I have not been a member of the AMA since Sunbeam. I agree with you 100%.

Steve, This is not Obamacare. It is Bushcare. The SGR is 6 years old, or have you not been paying attention. Neither the Republicans nor the Democrats give a **** about physicians.

At least I know my Senators do.

thats b/c one of your senators is a doc. now if we could just get rid of all the lawyers in washington, we'd be getting somewhere
 

RUOkie

10+ Year Member
7+ Year Member
Mar 3, 2009
760
52
171
Status
Attending Physician
thats b/c one of your senators is a doc. now if we could just get rid of all the lawyers in washington, we'd be getting somewhere
yup, Tom Coburn is from my town. And Inhoff's son is a hand surgeon.
 

drusso

Moderator Emeritus
Lifetime Donor
20+ Year Member
Nov 21, 1998
7,602
2,605
481
Over the rainbow
Status
Attending Physician
Typical PMR stuff, a dollar short and a day late.

Join the AAPS, suing the government for the Obamacare package. Abandon the AMA, and abandon any organized body that supported the reform package they just voted in.

Ah, the AAPS -- love'em, they're like the John Birch Society of organized medicine.

http://www.aapsonline.org/

But seriously, they're totally ineffective politically. I went to a AAPS mixer in Texas as a medical student. It was like "Come to Jesus" meets "conspiracy theory" with a sprinkle of X-files. It was a hoot... :laugh:
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
Congress passed paygo during their last session. Every piece of legislation must now have a means by which it can be paid for. Repealing the SGR is not revenue neutral, and would lead to between $130 and 290 billion budgetary shortfall.

Also, repealing the SGR without a solution regarding how to fix it is insufficient. Almost all of organized medicine (including the surgical subspecialties) support the SGR fix that was included in the original House healthcare reform bill (H.R. 3200)
 
Sep 30, 2009
170
1
0
Status
Academic Administration
Congress passed paygo during their last session. Every piece of legislation must now have a means by which it can be paid for. Repealing the SGR is not revenue neutral, and would lead to between $130 and 290 billion budgetary shortfall.

Also, repealing the SGR without a solution regarding how to fix it is insufficient. Almost all of organized medicine (including the surgical subspecialties) support the SGR fix that was included in the original House healthcare reform bill (H.R. 3200)
well OK but that doesn't mean we should sit on our hands now. The TMA, which is quite effective, has sent out a flyer to all member doc offices for docs to put in our offices for patients to read. It is not about the health care reform bill - it is about fixing the SGR issue. It has to be addressed. If not, doc payments will go to ZERO dollars as a logarithmic scale accelerates, so budget neutrality is all fine and dandy, but docs will not work for ZERO dollars I can assure you.

If this ain't fixed its over for Medicare patients being able to see a whole lot of their doctors. So there is no misunderstanding, large numbers of docs have stopped taking any new Medicare patients as of April 1st, when the 21.2% cut went into effect. In response, all Medicare contractors are not processing payments for DOS April 1st, 2010 and thereafter, giving congress a chance to act as soon as they return. CMS knows exactly what is going to happen and does not want to adjust their fee schedules mid year.

If practices still see Medicare patients, they will need to cut expenses by 21%, since most plans are based on Medicare rates at some level, in order to remain revenue neutral. Same for hospitals etc. Guess what happens? Staff and benefits will go right out the window. Then there really be a health care crisis.
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
If this ain't fixed its over for Medicare patients being able to see a whole lot of their doctors. So there is no misunderstanding, large numbers of docs have stopped taking any new Medicare patients as of April 1st, when the 21.2% cut went into effect. In response, all Medicare contractors are not processing payments for DOS April 1st, 2010 and thereafter, giving congress a chance to act as soon as they return. CMS knows exactly what is going to happen and does not want to adjust their fee schedules mid year.

If practices still see Medicare patients, they will need to cut expenses by 21%, since most plans are based on Medicare rates at some level, in order to remain revenue neutral. Same for hospitals etc. Guess what happens? Staff and benefits will go right out the window. Then there really be a health care crisis.
The sky is falling! The sky is falling!

Take a deep breath. No cuts went into effect - that's WHY contractors will hold on processing any payments - the rates will be adjusted retroactively.

Oh, and if you are going to no longer see Medicare patients, will you also not see any other patients whose fees are theoretically cut 21% (since most 3rd party payers will follow Medicare's lead)

Congress will patch this. They always do. No cuts will be implemented. Relax.
 
Sep 30, 2009
170
1
0
Status
Academic Administration
The sky is falling! The sky is falling!

Take a deep breath. No cuts went into effect - that's WHY contractors will hold on processing any payments - the rates will be adjusted retroactively.

Oh, and if you are going to no longer see Medicare patients, will you also not see any other patients whose fees are theoretically cut 21% (since most 3rd party payers will follow Medicare's lead)

Congress will patch this. They always do. No cuts will be implemented. Relax.
hey - your original post was a real problem and way off - so I do want to be sure that folks get it. I don't think you do. The sky is NOT falling for me personally. But it is heading the wrong way quickly for patients and younger physicians. For those not working on a salary in an academic center, I know you all get it. And many of my friends who are on a guaranteed salary get it too. The 21.2% cut DID go into effect April 1, 2010, and your post is actually not correct in that respect.

But yes it could be averted back to April 1, 2010, for yet another month or whatever. Medicare contractors ( NOT CMS) are holding claims because the cut technically went into effect April 1. Its a real issue and there is a very strong national movement to try and address involving very large numbers of docs who care and still want to see Medicare patients, as opposed to a growing number who simply do not anymore.

So hope you well join Roukie and I with our concerns for the welfare of our patients and physician peers.
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
hey - your original post was a real problem and way off - so I do want to be sure that folks get it. I don't think you do.
Really? So by all means, enlighten us - which part of my post was wrong? Cause I spoke to the attorneys and lobbyists at AAPM&R, the AMA, and the Alliance of Medical Specialties before posting. But if you have additional insight, by all means, please enlighten me.
The sky is NOT falling for me personally. But it is heading the wrong way quickly for patients and younger physicians. For those not working on a salary in an academic center, I know you all get it. And many of my friends who are on a guaranteed salary get it too. The 21.2% cut DID go into effect April 1, 2010, and your post is actually not correct in that respect.

But yes it could be averted back to April 1, 2010, for yet another month or whatever. Medicare contractors ( NOT CMS) are holding claims because the cut technically went into effect April 1. Its a real issue and there is a very strong national movement to try and address involving very large numbers of docs who care and still want to see Medicare patients, as opposed to a growing number who simply do not anymore.
No physician has EVER received a reduced payment because of SGR-based cuts. I have spoken to my Senators and Congrssional Representatives over the years. With the implementation of PAYGO, it is naive to walk into their offices and suggest they repeal the SGR, without also suggesting the budgetary offset that has to accompany such a bill.

Congress is going to be faced with Cap & Trade, Finance Reform, and Jobs bills the rest of the year. We are going to be a minor blip on their radar. Unless we come armed with fully fleshed out solutions, rather than another half-*****ed "Fix the Formula" campaign, they will placate us with more patches, and not resolve this issue for us once and for all.
 
Sep 30, 2009
170
1
0
Status
Academic Administration
Congress passed paygo during their last session. Every piece of legislation must now have a means by which it can be paid for. Repealing the SGR is not revenue neutral, and would lead to between $130 and 290 billion budgetary shortfall.

Also, repealing the SGR without a solution regarding how to fix it is insufficient. Almost all of organized medicine (including the surgical subspecialties) support the SGR fix that was included in the original House healthcare reform bill (H.R. 3200)
Well OK. here is your post - which was in response to Roukies original posting of what essentially is becoming a unified physician position.


Congress ignores their balanced budget rules every day and so mentioning anything about it is essentially worthless. it never happens and never will. Your first paragraph-in essence-says nothing.

Your second paragraph likewise also says nothing and is meaningless. Its basically some sort of therapeutic nihilism and sounds negative when some of us are actually trying to raise issues and generate positive ideas, discussion and participation.

It isn't at all necessary to "fix" SGR to understand that docs are pulling out of Medicare this month because of the lack of congressional action on delaying the implementation of SGR cuts. From a revenue /expense standpoint, some docs had no choice. If the cuts are not averted next Monday Medicare patients will have more and more trouble getting access, after working and paying Medicare taxes for lifetime. It is wrong and not necessary. health care employees will begin losing their jobs and benefits will be reduced. This is what businesses such as hospitals and practices do when the revenue/expense math doesn't add up. A 21.2% cut in revenues is not some small "oh the sky is falling issue" Are you on some sort of pharmaceutical agents?

extending jobless benefits should be a separate issue entirely from passing ( again) the delay of cuts due to the SGR...but it isn't they are tied together and will likely remain so until we get a change in Congress in the next election.

Are you on a salary? ( which is cool it just means you don't really feel any of this....for now)
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
Congress ignores their balanced budget rules every day and so mentioning anything about it is essentially worthless. it never happens and never will. Your first paragraph-in essence-says nothing.)
On February 12, 2010, President Obama signed House Joint Resolution 45, which contained a provision reinstating statutory PAYGO rules. These are now law, and are not ignored.

It isn't at all necessary to "fix" SGR to understand that docs are pulling out of Medicare this month because of the lack of congressional action on delaying the implementation of SGR cuts. From a revenue /expense standpoint, some docs had no choice. If the cuts are not averted next Monday Medicare patients will have more and more trouble getting access, after working and paying Medicare taxes for lifetime. It is wrong and not necessary. health care employees will begin losing their jobs and benefits will be reduced. This is what businesses such as hospitals and practices do when the revenue/expense math doesn't add up. A 21.2% cut in revenues is not some small "oh the sky is falling issue"
SGR-based cuts have NEVER impacted any practicing physicians, despite Congress having played chicken several times before. Thus jumping up and down and telling me your world is about to end becuase these very same cuts are going to be implemented, when they never have been at past deadlines is, in fact, akin to screaming "the sky is falling" when it obviously isn't.

extending jobless benefits should be a separate issue entirely from passing ( again) the delay of cuts due to the SGR...but it isn't they are tied together and will likely remain so until we get a change in Congress in the next election.
Senators Bunning and Coburn (the two legislators who have blocked the patch the past two months) are Republicans, so a change in the majority party of the Senate would in no way benefit our cause.

second paragraph likewise also says nothing and is meaningless. Its basically some sort of therapeutic nihilism and sounds negative when some of us are actually trying to raise issues and generate positive ideas, discussion and participation
The paragraph made reference to the proposed fix the AMA, AAPM&R, and Association of Medical Specialties support. I am sorry you feel their recommendation is meaningless.
 
Last edited:

nvrsumr

Member
15+ Year Member
Apr 25, 2002
1,840
437
381
na.com
Status
Attending Physician
paygo is ignored all the time. That was the whole issue with Sen Bunning and unemployment benefits a couple weeks ago.
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
paygo is ignored all the time. That was the whole issue with Sen Bunning and unemployment benefits a couple weeks ago.
PAYGO was signed into law February 13, 2010, so "all the time" is less than two months. The provision Senator Bunning was opposing was an emergency spending measure, not subject to the PAYGO rules. PATCHING the SGR is an emergency. REPEALING it is not.
 

nvrsumr

Member
15+ Year Member
Apr 25, 2002
1,840
437
381
na.com
Status
Attending Physician
This is not the first iteration of paygo. Bunnings wanted that bill to be within paygo and tried to force the dems to pay for the "emergency" spending. It was political grandstanding but I only mentioned it to show paygo is a joke.

I think a 20% cut is an "emergency" that may warrant consideration of spending outside of paygo but Im biased.