Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Docs Joust Over Medicare Advantage Payments

By Mary Agnes Carey and Susannah Crepet, CQ Staff

July 11, 2007 – While a group of California physicians on Capitol Hill Wednesday hailed the benefits of Medicare Advantage plans, the American Medical Association (AMA) made a counter move by reiterating its plea to lawmakers to trim payments to the plans. The jockeying occurred as lawmakers continue to mull ways to cut Medicare to pay for other health care priorities, including coverage of uninsured children.

The California Association of Physician Groups said during a press briefing that coordinated care delivered by Medicare Advantage plans creates "a level of quality and efficiency that is not possible in traditional Medicare." The plans do so by providing "evidence-based medicine" and more effective use of health information technology, the association said.

Donald Crane, the group's CEO, complained that in the current debate over Medicare Advantage, "there has been no meaningful discussion on the comparative abilities of Medicare Advantage and traditional Medicare in meeting the increasingly complex needs of a rapidly expanding population of seniors with extended life expectancy." The association's report said "it is the experience of more than 150 physician groups in California and the 59,000 physicians who are part of these groups that they are able to provide better health care to their patients who are in Medicare Advantage plans than those in traditional Medicare."

Some Capitol Hill Democrats are eager to cut Medicare Advantage reimbursements as a way to fund, for instance, expanded coverage of uninsured children through reauthorization of the State Children's Health Insurance Program (SCHIP). On average, Medicare Advantage plans are paid 112 percent of the rates paid in traditional Medicare, while private fee-for-service plans are paid 119 percent of those rates, according to the Medicare Payment Advisory Commission (MedPAC) and Congressional Budget Office (CBO).

But AMA officials said the physician group's report "offers no conclusive reason why the government should continue overpaying Medicare Advantage plans," and urged that the money be used to help prevent a 10 percent Medicare physician payment cut scheduled for Jan. 1. "Congress needs to do what's right for seniors by stopping harsh Medicare cuts ... that will make it very hard for physicians to care for new Medicare patients," said AMA board member Cecil Wilson said in a statement. "The most viable way to do that is to level the playing field by eliminating the Medicare Advantage overpayment."

Separately, executives of the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association—organizations that together represent 300,000 doctors—also urged Congress to prevent the scheduled 10 percent cut to Medicare physician payments.

At a Tuesday news conference, the groups said the sustainable growth rate formula (SGR) used to calculate Medicare payments to physicians does not take into account changes in practice patterns, coverage determination and new treatment options and technologies. Insufficient Medicare payments resulting from the SGR formula could reduce participation in the Medicare program and the amount of care available to Medicare patients, according to Rick Kellerman, president of the American Academy of Family Physicians.

Other speakers at the news conference agreed. "The U.S. health care delivery system is not broken, as Michael Moore would assert, but the Medicare physician payment system is 'sicko' and we, the representatives of the primary care physicians of the United States, 300,000 strong, are here in the nation's capitol today to fix it," said American Osteopathic Association Executive Director John Crosby.

An overhaul of the SGR could be attached to SCHIP reauthorization, Crosby and other speakers said.

Publication Details