The AMA's Weak Response to Medicare Cuts

June 3, 2010

The AMA is taking its usual ineffective tack in response to Congress' latest failure to address the looming 21% Medicare pay cut. Maybe, instead, it should try something that might work.

It's time for the AMA to rethink the way it's responding to Congress' failure to fix the 21% Medicare rate cut that doctors have been threatened with all year.

If you hadn't heard, Congress last week went into its Memorial Day recess without taking action, except to tell Medicare not to process any claims until June 15, by which time, presumably, it will have again delayed the cuts. Meanwhile, you'll continue treating patients -- your Memorial Day recess, after all, is over -- but your claims will be delayed. Again.

Eventually, Congress will return and delay the cuts again -- maybe for a few months, or maybe for a year or more. (The House passed a measure to delay the pay cuts until the end of next year, but the Senate failed to act.) But no one expects Congress to permanently fix Medicare's physician payment formula, called the Sustainable Growth Rate, whose calculations are responsible for the 21% cut in the first place. Practically everyone, it seems, agrees that the SGR must go. But fixing it would cost many billions that Congress does not have the stomach to spend.

The good news is that the AMA, increasingly outraged by this state of affairs, is taking action. The bad news is that it's taking roughly the same actions it has long taken and making the same statements it always does, while continuing to resist the get-tough strategies that won't win it more friends on Capitol Hill, but might actually get results.

The AMA held a press conference. President James Rohack, a cardiologist, unveiled a new media blitz denouncing Congress' failure to act, and Rohack had a few choice words for Congress himself.

Here's the TV ad:

Rohack also unveiled some results of an online poll of physicians, concluding that docs are fed up with Medicare's "chronic instability," and they're taking action. One in five physicians (one in three primary-care physicians) have already limited the Medicare patients they will take, either refusing to accept new ones or even dropping Medicare altogether, Rohack said. Fifty-four percent of docs surveyed said that without a permament SGR solution, they plan to limit their Medicare acceptance in the future -- even if Congress delivers another short-term payment cut delay.

But asked, repeatedly, which members of Congress, in particular, are most to blame, Rohack wouldn't bite. I asked if he'd care to name any particularly obstinate Senators. "Well, it's clear to us that all the Senators are going to have to take responsibility for this Medicare program," he replied. Well, sure, but some of them are willing to accept that responsibility, and some aren't, so who's who?

Too tough? OK, how about just telling us which party deserves more blame. Bob Lowes, a veteran healthcare journalist, noted that "all the initiatives to address the SGR problem have come from Congressional Democrats ... and have continued to run up against Republican resistance, based on opposition to deficit spending." So, he asked, "Don't the Republicans merit most of the indignation that you have?"

"Well," he replied, "we believe that this problem is owned by both parties and both houses."

Good grief. Talk about copping out. The trouble with the AMA is that it's so deeply entrenched in the culture of Washington's inside politics game that it won't risk alienating any of its powerful friends on important committees, or any who might eventually become more powerful. So it resigns itself to generic campaigns admonishing Congress, as if Congress were a coherent, monolithic body that just needs a kick in the pants, when in fact it's a messy political insititution with hundreds of different individuals. You want serious action on the SGR? There are only two ways: One is to wait for a genuine crisis -- say, when 70% or more of physicians won't accept new Medicare patients -- and it becomes politically impossible not to act. The other is to publicly embarass those members of Congress who refuse to act by naming them, and advertising in their districts.

By refusing to take the second route, the AMA is choosing the first by default. The ads urge citizens to call their Senators and demand action. I urge doctors to call their AMA delegates and demand MEANINGFUL action.