News

MSDC is asking private practice physicians who see Medicare and Medicaid patients to testify and comment at the upcoming American Medical Association Interim 2023 meeting at National Harbor.

To do either, you must be a member of the American Medical Association.

To testify in person, please come to the Gaylord Hotel on Saturday, November 11 between 12:30 and 5:00. More specific details are coming.

To provide comment in the online form, visit here (have your AMA log-in ready)

Background

At the 2023 Annual Meeting of the House of Delegates, the Medical Society of the District of Columbia introduced Resolution 108, “Sustainable Payment for Community Practices.” The reference committee recommended referral, and the House of Delegates supported this action. In response, the Council on Medical Service issued a detailed and helpful report.

Among the items in the original resolution was the call for a study of small medical practices to assess the prevalence with which private insurance payments are below Medicare rates and to assess the effects of these payment levels on practices’ ability to provide care. In calling for referral, the Reference Committee noted that the Council on Medical Service agreed with the necessity of such a study. Data from such a study would establish the extent of the problem and provide the necessary information to support legislative action.

However, the Council report did not set a study in motion. MSDC will respectfully ask that such a study be done and we are asking you to do the same.

A study could have two parts, both of which shall be divided by practice size, specialty, and location, among other relevant factors:

First, requesting data from payors as to the prevalence with which they offer to small, primary care practices sub-Medicare payments for common CPT codes, such as “99203: Office/Outpatient visit new patient,” or “99213: Office/Outpatient visit established patient.”

Second, collecting data from physicians in small primary care practices to assess the prevalence with which sub-Medicare payments have caused them to discontinue accepting insurance or to otherwise change their practices. Data from payors alone may be insufficient, as offering sub-Medicare payments to practices may rapidly force those practices to discontinue accepting insurance or take other action.

In addition, the Council’s report cited AMA policy D-400.990, which seeks legislation and/or regulation to prevent insurance companies from utilizing a physician payment schedule below the updated Medicare professional fee schedule, but did not suggest a pathway that would bring this forward.

For more information, contact MSDC or Dr. Neal Barnard, co-Chair of the Private Practice Physician Section and member of the MSDC AMA Delegation.