When a bipartisan mix of 100 House members urged the deficit-reduction supercommittee to search for cuts in federal spending, including entitlements, the California delegation didn't show much enthusiasm. Only six of the delegation's 53 members signed a letter to the Joint Select Committee on Deficit Reduction: Reps. Mike Thompson, Adam Schiff, Dennis Cardoza, Jim Costa, John Garamendi, and Devin Nunes. Reaction has highlighted a split in how these programs are viewed: Protecting Medicare and Social Security is far more urgent with many lawmakers than standing guard over Medicaid. Though he didn't mention Medicaid specifically, Rep. Sam Farr (D-Carmel), looks elsewhere before cutting social programs. "Before we look to slashing Social Security and Medicare, we have to look at cutting defense spending and closing tax loopholes that assure that corporations and the wealthiest 1 percent pay their fair share." One of those who didn't sign the letter to the supercommittee, Rep. Mary Bono Mack (R-Palm Springs), said she is concerned about federal spending but wants to protect programs Americans depend on. "The Congresswoman does not support any cuts to Social Security and Medicare benefits at this time, but Medicaid is certainly one area that should be looked at because of widespread waste, fraud and abuse which has occurred in the past," said her spokesman, Ken Johnson. Medicaid is the federal-state health care program for the poor, especially women and children and elderly in nursing homes. Medi-Cal, California's version of Medicaid, has 7.4 million users. Still, Bono Mack is far from the only California member to leave out Medicaid when stressing which programs to protect. Sen. Barbara Boxer (D-Rancho Mirage) wants a "balanced approach between cuts and revenues" when it comes to deficit reduction, spokesman Zachary Coile said. "She opposes efforts to slash Medicare and Social Security benefits for our seniors, but supports strengthening those very successful programs so that they continue to benefit future generations." Boxer's spokesman, too, said nothing of Medicaid. Source: The Californian, November 14, 2011.

The Centers for Medicare & Medicaid Services (CMS) has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. Click here to view the full listing (Revalidation Phase 1). Please note there are two sheets included in this Excel workbook. CMS will be updating this list in the download section of the Medicare Provider Supplier Enrollment Revalidation page on a monthly basis. If you are listed and have not received the request, please contact Palmetto GBA Provider Contact Center at (866) 932-3901.

The Centers for Medicare and Medicaid Services (CMS) revised downward a looming cut to physicians, but for the medical community, it will be cold comfort. On January 1, 2012, physicians face a 27.4% Medicare Sustainable Growth Rate (SGR) payment cut. The Deficit Committee may be our last chance to eliminate the SGR once and for all. SFMS/CMA believe that stable reimbursement in this program not only protects access to care but also makes economic sense as physicians are important employers in their communities. Repealing the SGR this year will saves hundreds of billions of dollars and put an end to these last minute legislative fixes that inevitably delay and increase the problem. SFMS/CMA has strongly opposed the proposed draconian cuts to Medicare physician payment and will continue to advocate for a repeal of the flawed payment formula and stable and adequate reimbursement for physicians. Please join us in this fight by contacting Congress and let them know the effect this cut will have on your patients and your practice! 

Talking Points

Please include a full repeal of the Medicare SGR in the Deficit Committee legislation.

• Failure to stop the SGR cuts will cause physicians to stop taking Medicare patients or close their doors altogether.
• With the baby boom generation fast approaching retiring age, we’re talking about decreased access to care for more than 5 million Californians.
• It will cause drastic access problems for seniors and military families who need a doctor.
• Repealing the SGR reduces taxpayer costs and the deficit—it is good economics.
• Five years ago the cost to repeal was $48 billion, now it is $300 billion; soon it will be $600 billion. These last minute stop gaps are increasing Medicare costs to the federal government. We must repeal the SGR once and for all.
• Physicians employ more than 500,000 people in California and are substantial contributors to the local, state and federal tax base. Maintaining appropriate, stable Medicare rates keeps physicians in practice and prevents further unemployment and economic erosion.
• Physicians are important businesses and employers crucial to the California economy.

How to Contact Members of Congress

USE THE AMA GRASSROOTS HOTLINE at (800) 833-6354 to call your Representative and Senators Boxer and Feinstein. You will be asked to enter your zip code and select your Representative. Please select your Representative first, then call back to connect with Senator Boxer and Senator Feinstein. EMAIL Senators Boxer and Feinstein through http://writerep.house.gov; www.boxer.senate.gov and www.feinstein.senate.gov. Also contact Congressman Becerra (D-LA), a member of the Deficit Committee at www.becerra.house.gov. Messages can also be sent to California Representatives who are in leadership positions: House Whip-Congressman Kevin McCarthy www.kevinmccarthy.house.gov; and House Minority Leader-Congresswoman Nancy Pelosi www.pelosi.house.gov.

More Information

Click here for background information about this issue.

Click here for a sample email to your Representative or Senator.

It’s almost Black Friday, when people across the country will be doing price comparisons to save money on their holiday gifts. And a new study shows that reducing price differences among hospitals could provide the U.S. health care system with a similar gift--lower costs. Researchers reporting in Health Affairs on Monday found that, after adjusting for factors like the severity of illness, Medicare payments to hospitals differ by more than $7,700 for back surgery and $6,900 for hip replacement. In each case, that is a difference of more than 30 percent between the hospitals in the highest-priced group and those in the lowest-priced group. Two other surgeries – coronary artery bypass grafting and colectomy to remove all or part of the colon – had price differences of more than 10 percent between the least- and most-expensive. “We were surprised by how much variability there was,” said lead author Dr. David Miller, a professor of urology at the University of Michigan Medical School. The study is just the latest to posit that significantly higher costs for some treatments are driving up health care costs overall. Miller and his colleagues analyzed Medicare payment data from January 2005 through November 2007. Payments were adjusted for factors like the mixture of different kinds of patients at a hospital, the severity of their illnesses and local payment rates for doctors. The payments were then grouped into five levels, from least to most expensive, before cost comparisons were made. One way to reduce a difference like the $7,700 for back surgery, according to experts, would be to move toward a bundled payment model for health care. Rather than pay providers per procedure, which is known as fee-for-service, providers would be paid per health care episode — for example, the treatment of a heart attack. Several health care systems across the country are currently testing bundled payments, as is the Center for Medicare and Medicaid Services. Success in reducing the disparity in payment rates among hospitals could depend on just how much bundling is done. Miller’s study found that the greatest factor affecting payment difference among hospitals was post-discharge care. With hip replacement, for example, post-surgery care accounted for 85 percent of the cost difference among hospitals. Medicare’s bundled payment demonstration project includes post-discharge care as an option, but it’s not a requirement for all those participating. “The data suggests that while the [Medicare bundled payment] program may yield some savings, there may be a better opportunity for savings” if post-discharge care were included, Miller said. Bundled payments also face several implementation challenges. Another Health Affairs study released Monday evaluated the first few years of three non-Medicare bundling projects. None had actually made a bundled payment as of May 2011, with participants faulting administrative and technical challenges, like not being able to recognize and track a health care episode in order to bundle the payments for it. Experience thus far shows that making bundled payments a reality is going to take “a really concerted effort” among health care providers, administrators, policymakers and others, said lead author Peter Hussey, a researcher with the RAND Corporation. While he remains cautiously optimistic about Medicare’s  test of bundled payments, he warns that reducing disparities in cost and deterring inefficient practices won’t be either simple or quick.  “Just because the variability [in Medicare payment] is there doesn’t mean it’s going to be easily removed,” Hussey said. Source: Kaiser Health News Capsules, November 7, 2011

CMS has extended the deadline to apply for Medicare e-prescribing hardship exemption to Tuesday, November 8, 2011. Click here to file for a hardship exemption.

Troubleshooting problems accessing the hardship exemption webpage

After reaching the hardship extension website, select Tools, then Internet Options, then Advanced in your internet browser. Scroll down toward the bottom and locate the “Use TLS 1.0” option. Place a checkmark next to “Use TLS 1.0.” Click OK. Attempt to access the site again. If you still have trouble accessing the site, the QualityNet Help Desk may be reached at (866) 288-8912 or by email at qnetsupport@sdps.org from 7 am to 7 pm Central Time, Monday through Friday.

hardship exemption categories include:

• Physician’s practice is located in a rural area without high-speed internet access.
• Physician’s practice is located in an area without sufficient available pharmacies for e-prescribing.
• Physician is registered to participate in the Medicare or Medicaid electronic health record (EHR) Incentive Program and adopted certified EHR technology by October 1, 2011, and did so prior to requesting an exemption.
• Physician is unable to electronically prescribe due to local, state or federal law or regulations.
• Physician infrequently prescribes (e.g., prescribe fewer than 10 prescriptions between January 1 and June 30, 2011).
• There are insufficient opportunities to report the e-prescribing measure due to program limitations.
• Physicians can apply for more than one exemption category if applicable to their particular situation

Exemption requests from individual physicians will not be accepted via mail, email or fax. Group practices already participating in the 2011 e-prescribing group practice reporting option must submit an exemption request via mailed letter (group exemptions cannot be submitted online or via email). For more information, please read SFMS’ blog post here.