The one-year freeze to the Medicare physician reimbursement cuts is just about over, and the issue is again at the forefront, as organized medicine tries to fashion a solution with Congress.

California Medical Association officials and physician leaders are vigorously urging legislators to scrap Medicare's flawed Sustainable Growth Rate (SGR) formula, which calls for a physician payment cut of 5.1 percent starting Jan. 1, 2007.

At press time, Jack Lewin, MD, the CEO of the CMA, was in Washington, D.C., meeting with members of Congress requesting they stop the cut and adopt a new formula based on the Medicare Economic Index (MEI), which would increase physician reimbursement by 2.8 percent in 2007.

"It's clear that every member of Congress is committed to fixing Medicare's SGR problem, but we could still be in store for a 5 percent cut anyway," Dr. Lewin says. "Unfortunately, the issues of immigration, Iraq and tax cuts are more important to Congress than access to physicians for senior citizens."

The SGR formula ties Medicare spending on physician services to the growth rate of the gross domestic product, but it actually penalizes physicians because the cost of physician services rises more rapidly than the GDP.

Reimbursement for all other Medicare providers is calculated using the MEI, which is a market index of actual medical practice costs. Hospitals and nursing homes are getting reimbursement increases, while physician reimbursement is being slashed.

Regarding taking action this year, Congressional leaders have hinted that they may only be able to freeze payments again at 2005 levels. With practice costs increasing at a rate of 4 percent to 6 percent a year, a payment freeze would essentially be a pay cut, physician leaders say.

However, the CMA has not been alone in combating Medicare payment cuts. In recent months, the American Medical Association was successful in getting 80 senators to sign a letter, which was sent to the U.S. Senate leadership, urging immediate action before the congressional recess in September. At press time, a similar sign-on letter was to be delivered to the U.S. House of Representatives leadership with more than 240 signatures.

On Sept. 13, the AMA embarked on a campaign to protect seniors' access to healthcare, during which hundreds of AMA physicians are expected to travel to Capitol Hill. The campaign effort includes a $1.5 million advertising campaign in magazines such as U.S. News & World Report, Newsweek and Ladies Home Journal.

"An AMA poll released in early September shows that, when told about the cuts, 86 percent of Americans are concerned that access to care for Medicare patients will be hurt," says Cecil B. Wilson, MD, AMA board chair. "Patients' concerns are justified. If Congress lets the cuts go through, physicians will be forced to make difficult practice decisions. Nearly half of physicians tell the AMA they will be forced to reduce or stop taking new Medicare patients if the cuts take place Jan. 1."

Even if doctors muster substantial support in Congress to correct the problem, time is running out. "I doubt Medicare's SGR will be fixed anytime this year, unless it could happen by some kind of miracle," Dr. Lewin adds. "But the CMA will be back in Washington in late September and we will be back in November, because we are going to keep trying for the miracle."