Once again, steep cuts in Medicare physician reimbursement loomed as the U.S. Congressional legislative session threatened to close before lawmakers agreed on a solution. Meanwhile, the American Medical Association and the California Medical Association continued to push for a long-term fix for the perennial problems arising out of Medicare's Sustainable Growth Rate formula.

At press time in mid-December, it was not clear whether Congress would pass a bill in 2007 preventing physician reimbursement cuts, nor whether President George W. Bush would sign it. The 2007 Congressional session likely ended on Dec. 21.

Senate Democrats and Republicans generally agreed it was a high priority to prevent the slated 10-percent cut in physician reimbursement under Medicare, according to CQ HealthBeat. Democratic proposals have depended for funding upon cuts to Medicare Advantage, including an early December plan to cut $14.8 billion. Medicare Advantage pays affiliated private insurers and providers.

Republicans threatened to block such legislation with a filibuster. President Bush was set to veto legislation that negatively impacts Medicare Advantage, according to a Dec. 4 letter from Michael Leavitt, secretary of the U.S. Department of Health and Human Services, to Senate Finance Committee Chair Max Baucus (D-Mont.). Instead, Leavitt said that legislators should "[p]ay for any adjustment to the physician fee schedule formula by responsibly adjusting payments to other providers in the fee-for-service Medicare program."

To avoid a veto, Baucus and other Democrats discussed attaching the Medicare modification to a larger, high-priority bill, such as an omnibus spending bill. "The update that the Medicare Payment Advisory Commission, which is Congress' advisory body on Medicare, has recommended for next year is 1.7 percent. That is what they've said will be the increase in medical practice costs for next year," an AMA spokesperson told Southern California Physician, noting that the group approved of that amount.

If a Medicare update did not pass in 2007, the 2008 Congress can make changes to the program retroactive to Jan.1. However, that route is expensive and difficult to manage, according to a spokesperson for the Centers for Medicare and Medicaid Services.

"We are down to the wire, as the cut begins on Jan. 1, so we're encouraging seniors and their loved ones to contact their senators and let them know action is needed now," said Edward Langston, MD, AMA board chairman in a Dec. 13 statement.

To push legislators into action before the end of the 2007 session, the AMA heavily lobbied senators and activated its grassroots network, the group's spokesperson said. "Let them know what they are going to do in their own practice, if this cut goes through," the spokesperson said. "It's not like this problem is going to go away, so [members] should get involved in the Physician Action Network to help us get the underlying problem, which is this fatally flawed payment formula, changed."

The CMA also urged members to contact Congress through the AMA to demand that they halt the 10-percent cut on physician reimbursement and provide a payment increase instead. The association called for funding of this initiative to come from an equalization of Medicare Advantage rates, rather than increasing SGR cuts in the future.