Private contracting in Medicare
ISSUE SUMMARY
The American Medical Association at its 2010 Annual Meeting of the House of Delegates passed substitute Resolution 204, which called for the development of federal legislation to allow an additional payment option in Medicare fee for service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule and in a manner that does not forfeit benefits otherwise available to the patient. KMS supported this resolution and has participated in the development of the proposed “Medicare Patient Empowerment Act,” which is to be introduced into Congress this spring.
The “Medicare Patient Empowerment Act” would establish a Medicare payment option for patients and physicians (and practitioners) to freely contract, without penalty, for Medicare fee-for-service physician and practitioner services, while allowing Medicare patients to use their Medicare benefits and allowing physicians to bill the patient for all amounts not covered by Medicare. Physicians and practitioners could continue to elect Medicare participating (PAR) or non-participating (non-PAR) status for other patients they treat.
Existing Medicare underpayments, coupled with the threat of continued steep payment cuts, present serious access to care and choice of physician problems because it is feared that fewer physicians will be able to afford to furnish services to Medicare patients. With the “baby boomer” population beginning to enter Medicare this year, alternative solutions to the physician payment problem are critical. Without some reform of the physician payment system the growing concern is that new and even current Medicare patients may not be able to find a physician to treat them.
Access to care and freedom to choose a physician have been key hallmarks of the Medicare program, and now these tenets may become extinct. A new approach, such as the “freedom to contract” approach taken in this legislation will help preserve the Medicare program, along with patient-centered care, for our elderly and disabled patients.
ADOPTED ACTION OR POLICY
Kansas Medical Society will work in concert with the American Medical Association to achieve passage of the “Medicare Patient Empowerment Act” that will allow an additional payment option in Medicare fee for service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule and in a manner that does not forfeit benefits otherwise available to the patient. Further, KMS will urge the Kansas Congressional delegation to support the passage of this legislation.
Adopted by the KMS House of Delegates on April 30, 2011.
