NATIONAL HARBOR, Md. -- The American Medical Association's policymaking House of Delegates voted nearly unanimously to continue its support of congressional efforts to repeal Medicare's payment formula despite .
The vote, which came here , comes with the added caveat that the AMA continue to push for future positive updates to physician payments under Medicare.
The AMA -- while backing the broader concept of a repeal of Medicare's sustainable growth rate (SGR) formula -- has strongly opposed the concept of freezing physician payments for a decade as part of the move to kill the SGR. A bipartisan proposal released late last month by the Senate Finance and House Ways and Means Committees calls for a 10-year freeze and a performance-based incentive program beginning in 2017 as part of an SGR repeal.
"I'm not going to sugar coat it. There are things I really don't like about the proposal -- chief among them, the idea of a 10-year payment freeze," AMA President Ardis Hoven, MD, . "It makes you want to throw up your hands and scream."
But she reminded delegates the proposal is just that -- a draft -- and there is an opportunity to advocate for elements they like and push for changes in those they don't. "And that's why we need to keep pushing," she said.
Wanting to seize on the momentum of an SGR repeal and voice its continued support for an SGR repeal, a coalition of delegates met over the weekend to craft a proposal that would satisfy the various constituents' concerns. The group developed a simple resolution that largely reiterates the AMA's policy to support an SGR repeal.
The resolution -- which backs an SGR repeal and supports the AMA's Pay-for-Performance Principles and Guidelines -- passed via voice vote with no calls for its rejection.
The motion does add an additional caveat that the AMA work to include an option for Medicare beneficiaries to privately contract with their doctors as part of Congress' efforts to repeal the program's much-hated payment formula for physicians. The concept would allow Medicare -- an option currently not allowed by Medicare.
The coalition comprised representatives from the New England delegation, the Florida delegation, and the California delegation, as well as from the American College of Physicians, the American College of Surgeons, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Academy of Dermatology, the American Association of Neurological Surgeons, the Medical Students Section, and the Organized Medical Staff Section.
The House of Delegates soundly rejected an amendment offered by the Louisiana delegation that would have had the AMA back an increase in physician payments equal to the cost-of-living adjustments seniors receive for Social Security payments.
Instead, they backed an amendment from the American Urological Association that calls for the AMA to advocate for increases in payments in the future. Opponents of the call for future updates cautioned that it may force the AMA to continue to focus on payment issues and not patient issues.
Lawmakers have yet to outline how they hope to pay for the SGR repeal, which is a significant hurdle in the way of the legislation's passage, but comments on the proposal were due last week with the hope that formal legislative language would be released soon.
, the association "strongly advocates" for some positive updates for physicians under Medicare.
The AMA is also worried that penalties under the proposed Value-Based Performance program be capped at 4%. The program would eliminate Medicare's various incentive programs such as and the and instead assess performance in quality, resource use, and clinical practice improvement activities. The AMA fears penalties in the program could reach 10%.
Physician payments will be cut by roughly 24.4% in 2014 unless Congress acts to forestall those cuts -- an annual step it has taken for more than a decade.