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Senate Democratic Leaders Land AMA Backing for Health Care Overhaul

By Jane Norman, CQ HealthBeat Associate Editor

December 21, 2009 –The American Medical Association (AMA) threw its weight behind the Senate health care overhaul bill Monday after changes were made to appease physicians, bringing aboard a group whose support was viewed as influential to passage of the House health care measure.

Cecil Wilson, president-elect of the AMA, appeared at an early-afternoon press conference with Democratic leaders to say that his group has been in “close communication” with leaders during the past few weeks. He said the AMA was happy that the bill (HR 3590), thanks to a manager’s amendment, now increases bonus payments to primary care physicians and general surgeons in medically underserved areas while not cutting payments to non-primary care physicians. In addition the amendment eliminates a tax on physician services for cosmetic surgery.

“We will work to resolve issues of concern to physicians such as the creation of a Medicare payment board, quality improvement and Medicare data release initiatives,” said Wilson, an internist from Florida. While a permanent fix for cuts in the Medicare physician payment system is not part of the deal with Senate Democratic leaders, “we will continue to work closely with them to get that solution,” he said. A two-month patch to avoid cuts in doctor payments is part of a defense appropriations bill (HR 3326) signed into law by President Obama on Saturday.

Another big plus for doctors was the Senate’s decision to drop a proposal to allow people age 55 to 64 to buy in to the Medicare program, which pays lower rates than private insurance. Wilson said afterward that physicians made their unhappiness with that idea very clear.

Wilson also said that the AMA was also pleased that an enrollment fee was eliminated from the Senate bill that would have required physicians to pay for participating in the Medicare and Medicaid programs. He said the fee initially was set at $300 per physician, then was lowered to $200 and then was eliminated. “The ostensible reason for that fee was to help cover some of the expenses for fraud and abuse kinds of activity,” he said. “What we would say is that is something society ought to bear, that it’s inappropriate to put a fee on physician payments, in essence.”

The AMA is committed to change and realizes no bill is perfect, he said. “What we also said is we’re not going to stand on the street corner and yell it,” said Wilson. “What that leads us to is a process which says at the end of the day, when we are approaching conference committee and what the results will be from that, we will look at the whole package.”

A major issue is the viability of the Medicare program and adequate payments for doctors under the payment formula, he said. The AMA has had assurances from Majority Leader Harry Reid, D-Nev., and Senate Finance Committee Chairman Max Baucus, D-Mont., that “it is important to them as well,” Wilson said. Earlier this year senators defeated another bill (S 1776) that would have prevented future cuts in doctor fees, with some Democrats saying they could not support it because it would have added $247 billion to the deficit over the course of a decade.

The House on Nov. 19 approved HR 3961, which create a new Medicare payment formula for physician services. It would block a 21 percent cut scheduled to take effect in January 2010, and increase the payment rate based on the Medicare economic index.

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