American Chiropractic Association Assails Proposed Medicare Payment Cuts

DCs Could Face 13.1 Percent Reduction in Medicare Reimbursement Rates The American Chiropractic Association (ACA) is calling on Congress to halt proposed reductions in Medicare physician payments scheduled to take effect Jan. 1, 2007, that could seriously jeopardize access to care for millions of Medicare patients and would significantly reduce chiropractic reimbursement rates under Medicare. ACA says that changes recently proposed by the Centers for Medicare and Medicaid Services (CMS) as part of a congressionally mandated five-year review undermine Congress’ goals of preserving patient access and achieving greater quality of care. The association is pressing for a one-year delay in implementation of the cuts to provide CMS more time to assess the negative impact of the changes. ACA is also pressing Congress for action on another possible Medicare cut, which involves a legally mandated formula—the Sustainable Growth Rate (SGR)—to control Medicare spending. ACA is urging Congress and CMS to explore alternatives to the “inequitable” formulas used to determine physician reimbursement and to correct the system that consistently leaves millions of beneficiaries’ care in jeopardy each year. Proposed Cuts Vary Among Provider Groups This action comes on the heels of two proposed notices released by CMS that outline its plan to revise the way it calculates “relative value units” (RVUs) – or the costs associated with various health care services – under the Medicare physician fee schedule. CMS has proposed to offset an increase in payments to physicians who use higher-level evaluation and management (E/M) services by applying a budget neutrality adjuster across work RVUs for all health care services by 10 percent. This adjuster results in significantly different outcomes depending on the codes a given provider community uses. While some physicians will benefit from the increase in payments for higher-level E/M services, many health care providers will experience a dramatic overall decrease in reimbursements – particularly those providers who cannot bill for or do not frequently use higher-level E/M codes when submitting Medicare claims. In fact, certain health care professionals could experience payment cuts of as much as 15 percent by 2010 in this area of the Medicare payment formula alone. In 2007, doctors of chiropractic are slated to take an 8 percent cut in reimbursement. These cuts under the proposed notice would come in addition to a projected 5.1 percent reduction in payments based on the Sustainable Growth Rate (SGR) – a formula used to control the growth in Medicare. The combination of these requirements and proposals would result in a 13.1 percent total decrease to chiropractic reimbursement rates effective January 1, 2007. ACA Seeks Long-term Solution In addition to seeking immediate congressional action to delay the proposed rule, ACA is pressing for a fix to the Sustainable Growth Rate (SGR) formula. It is advocating not only for addressing next year’s 5.1 percent payment cut, but also to create a long-term policy solution that would lead to more accurate physician reimbursement. “Congress needs to act to halt or fix each of these cuts. CMS should explore ways to value patient time without reducing patient access to care by providers who would be forced to limit services due to such severe reimbursement cuts,” said Richard Brassard, DC, president of the American Chiropractic Association. “Preventing these cuts will ensure that Medicare beneficiaries continue to have access to valuable health care services, including doctors of chiropractic.” How Can Doctors of Chiropractic Help? The American Chiropractic Association is urging its members and chiropractic patients to lobby Congress on this issue before a final rule is unveiled by CMS later this year. Specifically, the ACA is asking doctors of chiropractic to contact their U.S. Representatives and Senators and ask them: To delay for at least one year implementation of the proposed rule as published in the June 29, 2006, Federal Register (71 Fed. Reg. 37170). Preventing these cuts will ensure that Medicare beneficiaries continue to have access to valuable health care services. In delaying implementation, Congress should also require CMS to determine the impact that these severe payment cuts will have on patient access to services. To sign on to the Cardin-Johnson Letter. A letter is being circulated around the U.S. House of Representatives that asks for Congress to take action and prevent the 5.1 percent decrease to the SGR from taking effect. Available on ACA’s Web site is a list of members of Congress who have NOT signed onto this letter as of Sept. 7. If your member of Congress is on this list, please contact him/her and ask them to sign onto this important bi-partisan letter. If your member is not on the list, please contact them and thank them for their support. Representatives and Senators can be reached via the Capitol switchboard at (202) 224-3121 or via the ACA Legislative Action Center. For more information, visit ACA’s Web site at:

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