Cost-cutting measures should not be at the expense of patient care – Dr. Dorkin

Posted in Health Policy, Medicare, Medicine on April 2nd, 2018 by MMS Communications – Comments Off on Cost-cutting measures should not be at the expense of patient care – Dr. Dorkin

It’s no secret that health care in the United States – including here in the Commonwealth – is expensive, and the rising cost of prescription drugs plays no small role in that.

However, as physicians who are dedicated to the health and wellbeing of our patients, we cannot prioritize cost-cutting measures over the ability of our patients to get the treatment they need.

I understand firsthand the importance of treatment options when it comes to the children for whom I provide care. Quite simply, some medicines work better for certain patients. When it comes to asthma or cystic fibrosis – conditions that I treat – the difference between medicines can mean life or death.

I also know that new medications can make life-changing differences in the health of my patients. Once the U.S. Food and Drug Administration has completed its thorough review of a new drug – after years and years of research and development – it is imperative that I be able to introduce that medicine to appropriate patients, rather than waiting for an additional state-level review.

I raise these points because of my concern – as a physician and as the president of the MMS – with the proposed MassHealth closed drug formulary.

Our Massachusetts health program, admittedly, takes up a large share of the state budget. At the same time, the benefit to our community is significant, and it is why the Commonwealth is viewed as a trailblazer when it comes to health care delivery innovation.

All of our patients matter. Those who are covered by MassHealth – adults and the disabled who get their care through Medicaid and children who are insured under the Children’s Health Insurance Program – deserve just as much access to care as any other patient.

A closed drug formulary will limit the ability of physicians to give their patients the care they need. While a proposed exception process has been created, this will only lead to additional delays in treatment for patients and administrative burdens for doctors. Again, this is not in the interest of improved patient health, but rather in reduced health care costs; that’s why we urge MassHealth to accept physician input in creating this process.

In light of a renewed dialogue about the MassHealth closed drug formulary proposal, I urge MMS members to revisit our submitted comments, and share your thoughts on the impact of such a formulary, if implemented, in the comments to this post.

Again – the Medical Society recognizes the difficulties in balancing MassHealth’s mission to provide comprehensive care to roughly two million residents with the very real budget limitations that the program faces. We simply want to ensure that the tough decisions this balance requires do not interfere with quality care for the patients of the Commonwealth.

Henry L. Dorkin, M.D, FAAP, President, Massachusetts Medical Society

Kiss the SGR Goodbye: Senate Repeals Medicare Payment Formula

Posted in Medicare on April 14th, 2015 by MMS – 1 Comment

US Capitol 1In an historic vote Tuesday night, the U.S. Senate finally repealed the flawed Medicare payment formula that has been plaguing physicians for more than 17 years. The final vote was 92-8. Senators Markey and Warren voted in favor.

To get there, the Senate spent more than two hours trudging through votes on six different amendments from both Republicans and Democrats. Only one vote was close – it would have removed caps on therapy services. If any single amendment had passed, the bill would have returned to the House, whose leaders had already said they would not agree to any more amendments.

The vote came just hours before Medicare would have been forced to cut payments by 21% for all services provided after March 31. But that’s not going to happen – President Obama will sign the bill.

The legislation guarantees physicians a 0.5% rate increase every year through 2019, when a series of quality incentive payments become available. The first 0.5% increase takes effect July 1, 2015, followed by another 0.5% increase on Jan. 1, 2016.

Medicare Initiates Plans to Pay Claims With 21% Cut

Posted in Medicare on April 14th, 2015 by MMS – 1 Comment

Photo by frankleleon, via flickrUPDATE: 10:30 a.m., 4/16/15

The Senate repealed the SGR on the evening of April 14.  However, because the bill has not yet been signed, a small number of claims are being processed at the reduced rate, on a rolling basis.

When the bill is signed, Medicare’s contractors will automatically reprocess those claims at the higher rate.

With the Senate’s vote on the SGR repeal legislation still up in the air,

Medicare’s billing contractor announced that on April 15, it will start processing April claims at reduced rates, on a first-in, first-out basis.

Medicare payment rates were cut by 21% on April 1, following the expiration of the latest SGR payment “patch.” CMS routinely holds claims for 10 business days, so until now, practices’ cash flow was not affected. This “rolling hold” is designed to minimize the impact on practices to greatest extent possible.

There’s still a chance the repeal will pass by April 15. But if Congress acts after April 15, the new rate would be retroactive to April 1.

If there’s any positive news here, it’s that practices will NOT be required to resubmit claims initially paid at the lower rate. National Government Services said it will automatically reprocess those claims and issue checks for the difference.

Claims for services provided before April 1 are not affected by the payment cut.

For more information, visit the National Government Services website.

U.S. House Makes History, Votes to Repeal Medicare SGR Payment Formula

Posted in Medicare on March 26th, 2015 by Erica Noonan – Comments Off on U.S. House Makes History, Votes to Repeal Medicare SGR Payment Formula

IPhoto by wallyg, via flickrn a historic move, the U.S. House of Representatives voted overwhelmingly Thursday in favor of repealing the flawed Medicare physician payment formula by a vote of 392-37. All Massachusetts members voted in favor of the bill.

The $200 billion package, widely embraced by both political parties, calls for a permanent repeal of the Sustainable Growth Rate, or SGR, that has threatened physicians with double-digit reimbursement cuts 17 times over the past decade.

MMS President Richard Pieters, MD, applauded the House’s action, calling it critical to re-establishing a stable environment for physicians and more than 1 million Massachusetts seniors who depend on Medicare.

“We thank the lawmakers on both sides of the aisle who came together on behalf of the nation’s seniors and military families who depend on Medicare and their doctors to stay well,” said Dr. Pieters.

“Thank you to the tens of thousands of physicians and patients who heeded our calls to contact their representative in Congress this week. Your voices were heard,” he said.

The Senate will not consider the measure until it returns from its Easter recess in mid-April. If it is successful there, President Obama has indicated he will sign the measure into law.

The most recent Medicare payment patch expires March 31. The next day, a 21 percent cut is scheduled to take effect. However, CMS doesn’t process claims until two weeks after date of service, so if the Senate acts quickly enough, physicians’ first payments for services provided after April 1 will not reflect the 21 percent cut.

The MMS will update its website and social media channels frequently with news of the bill’s continued progress through the Senate.  Read more on the MMS website about the effort to repeal the SGR.

Recapping a Busy Year: MMS Health Care Advocacy in 2014

Posted in Annual Meeting 2014, Electronic health records, Health Reform, meaningful use, Medical Marijuana, Medicare, Payment Reform on May 15th, 2014 by MMS – Comments Off on Recapping a Busy Year: MMS Health Care Advocacy in 2014

Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, kicked off the Society’s 2014 Annual Meeting with a review of five significant advocacy issues from the 2013-14 year:

  • Medicare payment
  • ICD-10 deadlines
  • Regulatory overreach
  • State regulations on EHRs
  • Medical Marijuana


Senate Extends Medicare Payment “Patch” for One Year

Posted in Medicare on March 31st, 2014 by MMS – Comments Off on Senate Extends Medicare Payment “Patch” for One Year


The Senate today approved a one-year extension of the current Medicare payment formula, rejecting a last-ditch effort by Sen. Ron Wyden (D-Ore.) to replace it with a permanent repeal of the entire payment formula.

The legislation averts a 24 percent cut in Medicare payments, which was scheduled to take effect on April 1.  For the rest of the calendar year, physicians will get a 0.5% increase. Rates will be flat for the first three months of 2015, at which time another cut is scheduled to take effect.

The legislation also delays the implementation of the new ICD-10 diagnosis code set until Oct. 1, 2015.

The final tally on the so-called “patch” bill was 64 to 35. Sixty votes were needed for passage. Both Massachusetts senators voted reluctantly in favor of the patch, and would have supported a permanent repeal if it were up for a vote today.

The MMS and AMA have opposed the patch bill (the 17th in the last 11 years), preferring a complete repeal of the payment formula.

MMS President, Ronald W. Dunlap, MD, said, “We’re very disappointed that Congress has again failed to fix the deeply flawed Sustainable Growth Rate Medicare payment formula. The legislation is sound policy that was supported by both parties, in both chambers of Congress. Yet, because its leaders were unable to overcome partisan differences over how to pay for it, we now have the 17th SGR patch in the last 11 years.

“The bitter irony is that every patch makes the problem worse. Congress could have solved the problem years ago by enacting a permanent repeal, and would have saved taxpayers tens of billions of dollars.

“The campaign to fix Medicare must continue, for the sake of the millions of seniors and military families who depend on the program for their health care. We’re deeply grateful to the members of the Massachusetts congressional delegation for their steadfast support for true Medicare payment reform, and pledge to work with them to achieve this goal – once and for all.”

We would like to thank the many physicians who contacted our congressional delegation to urge rejection of the measure.

Over Protests, House Passes One-Year Extension to Medicare Payment Formula

Posted in Medicare on March 27th, 2014 by MMS – Comments Off on Over Protests, House Passes One-Year Extension to Medicare Payment Formula

us-capitol-building-2Despite strong protests from much of organized medicine, the U.S. House today approved – without a roll call –  a one-year extension of the current Medicare payment formula.

The Senate is expected to vote on the bill on Monday at approximately 5:00 p.m.

The “patch” legislation – as it is called – averts a 24% cut at least until April 1, 2015. It would give physicians a 0.5% raise through the end of calendar 2014, and no increase for the first three months of 2015.

The MMS, the American Medical Association and many other physician organizations bitterly opposed the bill, saying they preferred pending legislation that would completely repeal of the payment formula, known as the Sustainable Growth Rate (SGR).

The patch would also delay the implementation of ICD-10 for one full year, to October 2015. That prospect might ordinarily delight the AMA, which opposes ICD-10, but it wasn’t enough to soften the AMA’s opposition to the patch bill. Hospitals and technology groups that have heavily invested in ICD-10 criticized the delay.

This is the 17th time in 11 years that Congress has extended the current payment formula. The AMA’s opposition to this patch was rooted in its contention that it would force a fresh restart of the debate in the new Congress next year. It also protested that the patch legislation appropriates money that would have been used to pay for the repeal, making full repeal even more difficult in the next session of Congress.

The legislation fully repealing the SGR has been supported by both parties, in both chambers of Congress – a very rare phenomenon. But that bipartisan consensus crumbled over a rancorous debate over how to pay for it. Republicans wanted to fund it by delaying the Affordable Care Act’s individual mandate, while Democrats wanted to apply unused military funds. Neither party’s solution was even remotely palatable to the other.

For a brief period of time, the fervent protests of organized medicine seemed to be derailing the patch bill. After some debate on the House floor Thursday morning, there was no quorum to take a vote, and it was taken off the House calendar. But the bill returned to the podium about 90 minutes later, where it was gavelled through a voice vote in about 30 seconds (see video clip below).

House Schedules a Thursday Vote on Another Medicare Patch; AMA Urges No Vote

Posted in Medicare on March 26th, 2014 by MMS – Comments Off on House Schedules a Thursday Vote on Another Medicare Patch; AMA Urges No Vote

39With the debate about how to fund a bipartisan bill repealing the Medicare physician payment formula stalled, the House is set to vote Thursday morning on a bill to extend the current payment formula for 12 months. For parliamentary reasons, a two-thirds majority is needed for passage.

The MMS, the American Medical Association, the American College of Surgeons, American College of Physicians, the American Osteopathic Association, the American Academy of Family Physicians, and many other physician organizations are strongly opposing the bill. They’re calling on the House and Senate to continue working on permanent repeal instead.

The House measure includes a surprise: A 12-month delay in the implementation of the ICD-10 coding system until October 2015. The American Health Information Management Association quickly opposed the delay, saying it would be costly to health care providers. The AMA opposes the implementation of ICD-10 outright, but this provision has not changed the AMA’s mind about the overall bill.

The 16th and most recent extension of the current payment formula is scheduled to expire on March 31. Without further action, a 24 percent cut in Medicare payments is scheduled to take effect on April 1.

House and Senate Committees Approve Bills to Repeal the SGR

Posted in Medicare on December 12th, 2013 by MMS – 2 Comments

photo by Photo Phiend via flickr.comUPDATED: Dec. 19, 2013

The House Ways and Means Committee and the Senate Finance Committee  have approved bills that would repeal the Sustainable Growth Rate (SGR) Medicare physician payment formula, and replace it with a program that rewards physicians for meeting currently undefined quality benchmarks.

The bills are fundamentally similar. They would:

  • Repeal the SGR
  • Allow physicians to continue to be paid on a fee for service basis
  • Provide incentives for physicians who participate in alternative payment programs and patient-centered medical homes
  • Consolidate all existing federal quality reporting programs into a single program
  • Establish bonuses and penalties for meeting certain quality benchmarks, starting in 2017 for performance in 2015. The maximum bonus would grow incrementally to 10% by 2020.

The key difference between the two bills is that the House measure provides for a guaranteed 0.5% annual increase in base fee-for-service payments, for three years. The Senate bill has no increase.

There’s no way Congress can complete action on the legislation before the end of the calendar year. So Congress has approved a budget agreement that would pay doctors at current Medicare rates for three more months, plus a 0.5% increase. This “bridge” measure avoids the disruption that would have been caused if the 24% cut in the payment formula have taken effect on Jan. 1, as previously scheduled.

The President’s Podium: Getting Closer to a Medicare Payment Fix

Posted in Health Policy, Medicare, Payment Reform on September 18th, 2013 by MMS Communications – Comments Off on The President’s Podium: Getting Closer to a Medicare Payment Fix

by Ronald Dunlap, M.D., President, Massachusetts Medical Society

Mention “SGR” to physicians and you can almost see and feel the tension and level of frustration.

For nearly a dozen years, this Sustained Growth Rate formula has called for massive cuts in Medicare reimbursements to physicians.  For each of those years, Congress has stepped in at the eleventh hour to avoid the cuts and provide a modest increase. Yet, for all those years, physicians worried about the viability of their practices and their patients.  And patients, having read and heard media reports about the possibility of physicians abandoning Medicare because of potential cuts in payments, may have wondered if they would continue to have a doctor.

We’re now closer to a permanent fix than ever before. On the last day in July, the House Committee on Energy and Commerce reported the “Medicare Patient Access and Quality Improvement Act” by a unanimous vote of 51-0. That bill repeals the SGR and replaces it with annual updates and new quality incentive measures.  Adding to the hope of a fix is a report from the Congressional Budget Office that estimated the cost to eliminate the SGR formula at about half the price of repeal last year.

However, two additional committees, House Ways and Means and Senate Finance, are scheduled to produce their own versions of the legislation, which will likely be combined and then brought to a vote in both the House and Senate.

While the 51-0 vote and CBO report raise hope, the work is far from done. Many key issues remain to be resolved, among them the adequacy of the proposed increases, the complexity of the new quality reporting system, and provisions for small practices that will allow them to maintain their viability and keep their doors open for their patients.

The AMA, in an effort to keep the momentum going, has launched Fix a website with three distinct channels: one each for physicians, patients, and policymakers, allowing each a voice on the subject and the ability to participate in the discussion.

The Massachusetts Medical Society, with the participation of many of our district presidents who have written letters to the editor to newspapers and media outlets across the state, has encouraged our Senators and Congressional representatives to make these changes a priority for Congress and finally reach a reasonable “fix” for a problem that has long plagued physicians and patients alike.

A new and better payment formula and better quality measures will help to stabilize Medicare for years to come. It will ease the minds of Medicare and Tricare patients in knowing their doctors will be there for them.  We’ve never been closer to fixing a broken system. It is imperative that physicians and patients alike maintain the momentum by urging Congress to capture the opportunity before them.

The President’s Podium appears regularly on the MMS Blog and offers Dr. Dunlap’s commentary on a range of issues in health and medicine.