AHIP Rallies Support of Physician Groups Against CMS’ Estimated 2010 Medicare Advantage Payment Rates
America's Health Insurance Plans on Monday sent several physician groups a letter asking for support to pressure CMS to change estimated Medicare Advantage payment rates for 2010, CongressDaily reports. AHIP says the rates will lead to higher premiums and reduced benefits for seniors.CMS in February included a pending 21% Medicare physician payment cut in its draft calculation of 2010 MA payment rates. According to CongressDaily, Medicare physicians face payment reductions almost every year under the sustainable growth rate formula, which requires payment reductions when spending reaches a certain level. However, Congress passes legislation to avoid the cuts each year.
According to AHIP spokesperson Robert Zirkelbach, the payment reduction will result in MA plans having to make "tough decisions" to offset the cuts, either through higher premiums or reduced benefits. Zirkelbach added that "some plans may even go out of business." AHIP estimates that MA payments ultimately will be reduced by 5%. AHIP's estimate includes the CMS physician payment cut and CMS' plan to more closely align risk adjustments to help determine payment rates. Higher-risk patients mean larger payments, according to CongressDaily. Zirkelbach said MA plans have more higher-risk patients.
The letter states, "We are working hard to avoid reductions that will cause disruptions to beneficiary services. We also would appreciate your calling this issue to the attention of your members and join us in asking your congressional representatives to urge CMS to implement a solution to this problem that would reflect the anticipated congressional action to avoid the 20% reduction."
A doctor interviewed by CongressDaily said that physicians are less concerned with the payment cuts than AHIP because several factors were considered in CMS' 2010 payment rates, including "the business practices of MA plans over the past few years" (Edney, CongressDaily, 4/1). This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
