The Society Lobbies Congress to Fix Pay Discrepancies

In the last year, The Endocrine Society has advocated diligently on Capitol Hill for improved payments for endocrinologists. Halting potential payment cuts resulting from the Sustainable Growth Rate (SGR) and the expiration of a fee-fix for dual-energy X-ray absorptiometry (DXA) tests have been a key focus in these efforts.

Repealing the Flawed SGR

Congressional delay in repealing the Sustainable Growth Rate (SGR) formula, a methodology originally intended to control the growth of Medicare fees for physician services, creates cliffhanger anxiety among doctors year after year. Although legislators were able to agree on a temporary fix in February to avert a 27.4 percent payment cut, doctors may now face a 35 percent reduction come January 2013. The Society has been an advocate for the permanent repeal of SGR a formula that results in dramatically reduced Medicare reimbursements to doctors. The Society recommends replacing the flawed formula with five years of stable payments to allow for the testing of new payment models. In addition to a feefor-service system, physicians should have the option of being reimbursed through a menu of payment models. With that goal in sight, the Society’s Clinical Affairs Core Committee has met with payment experts to help identify which model could be most beneficial to endocrinologists.

In anticipation of the 2013 expiration of the temporary SGR fix, Congress has been evaluating payment options that could replace the impaired system while addressing current workforce shortages that have impeded patient access to care. Congress has used incentive payments in the last several years, but the bonus payment plans stipulate that a physician must be one of several specialty designations (such as an internist, geriatrist, or pediatrician) and bill at least 60 percent primary care services. Cognitive specialists, such as endocrinologists or rheumatologists, however, have been excluded from the bonuses, even though they provide a significant amount of primary care services and face many of the same hurdles as primary care in attracting medical students. The Society has been actively lobbying legislators and regulators to address this discrepancy.

Establishing New Payment Plans

On May 9, 2012, Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV) introduced the Medicare Physician Payment Innovation Act that would eliminate the SGR and establish the framework for new payment models. A provision included in the legislation would implement temporary, four-year differential updates to payments for physician services. For years 2014 to 2017, the bill provides an annual increase of 2.5 percent to physicians who bill at least 60 percent of Medicare allowable charges for primary care, preventive care, and care coordination services, while all other physicians receive a 0.5 percent update. The differential increases are designed to address the undervaluation of primary and preventive care and care coordination services.

The Society has endorsed the legislation and will work with Representatives Schwartz and Heck to build support in the House of Representatives. The Society will continue to remain active in the Cognitive Specialties Coalition, which works to bring awareness of the importance of and value that cognitive specialists bring to the care of their patients. To that end, the Society and coalition members have met with more than 200 congressional offices to discuss these issues and will continue to work to ensure improved payments for the cognitive specialties.

Payments for Bone Scans

On March 1, 2012, payments for DXA services in a physician’s office dropped nearly 50 percent due to the expiration of an Affordable Care Act provision that had bolstered rates for these services for two years. The Society has been actively lobbying Congress to pass the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011, which would improve payments for these services. The bill, which is sponsored by Representatives Michael Burgess (R-TX) and Shelley Berkley (D-NV) and Senators Olympia Snowe (R-ME) and Debbie Stabenow (D-MI), would set DXA rates at 70 percent of the 2006 level (approximately $98) for an additional two years.

During the debate on the Middle Class Tax Relief and Job Creation Act of 2012, Capitol Hill supporters attempted to include the DXA provision. The Society mobilized key grassroots members and initiated a letter-writing campaign, and the DXA Coalition also rallied support. Despite the massive effort, the osteoporosis bill was excluded from the legislation.

The Endocrine Society, along with the members of the DXA coalition, will continue to work with Congressional sponsors to identify a legislative route for a solution to the payment decreases while addressing concerns of a lack of data regarding the impact of the cuts.

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