The Brigham and Women’s Physicians Organization (BWPO) and the Massachusetts General Physicians Organization (MGPO) joined to forces to advocate concerns associated with recent changes in Medicaid and Medicare reimbursement rates on behalf of physicians at both organizations.
Medicaid
Andrew Sussman, MD, BWPO chief medical officer, and James Heffernan, FHFMA, MGPO treasurer and chief financial officer presented testimony related to changes in Medicaid payments to the Department of Healthcare Policy and Finance in late December. Although Sussman and Heffernan acknowledged the Commission’s work on improving the rates for evaluation and management codes, they asked the Commission to reconsider the Partners physician payment legislation and the restoration of Medicaid “cross-over” payments.
The current Medicaid professional reimbursement rates cover only 70 percent of physician costs. Therefore, the Partners physician legislation recommends rate increases to cover cost, timely payment, study of the impact of Medicaid rates on physician practice and the implementation of disease management programs. Medicaid also recently eliminated “cross-over” payments, which account for approximately 15 percent of Partners’ Medicaid professional payments and allow for coverage of co-payments that Medicare does not cover for dually eligible patients. According to Sussman, patients who are eligible for both Medicare and Medicaid may be individuals with high medical costs and patients who require significant physician time and commitment. Partners and the Massachusetts Medical Society have pushed to re-institute “cross-over” payments in order to prevent further decreases in reimbursement for such patients.
Medicare
Medicare payments to BWPO physicians are set to decline by 6.7 percent in 2002 based on changes in the methodology of payment proposed by the Centers for Medicare and Medicaid Services. This could result in a $2 million reduction in revenue for the BWPO. In response to these changes, the BWPO, along with local and national health care allies, supported the “Medicare Physician Payment Act of 2001” presented to Congress in December. While the bill did not pass in the fall, it will be reconsiderd in the winter session. Congress did pass legislation directing the Medicare Payment Advisory Committee to examine ways to replace the current methodology and report back to Congress by March. The BWPO will continue to participate in ongoing efforts at local and national levels to reverse these changes.