American College of Physicians: Internal Medicine — Doctors for Adults ®


Medicare win showcases the power of grassroots advocacy

Physicians will receive a 1.6% raise instead of a 4.4% cut. The College's efforts helped win the fight.

From the March ACP-ASIM Observer, copyright 2003 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

For more than a year, physicians have sought help from Congress to halt devastating cuts in Medicare payments to doctors. And for much of that time, it seemed that their pleas were for naught.

Back in December 2001, physicians wrote to lawmakers urging them to pass legislation that would halt an upcoming 5.4% cut in Medicare payments. Even though a majority of Senators and Representatives agreed to support the bill, Congress adjourned for the year without taking action, and the cut went into effect on Jan. 1, 2002.

Last year, physicians again urged Congress to pass legislation to avert further cuts and replace them with positive updates. Although the House of Representatives included such measures in its version of prescription drug legislation, the bill died in the Senate.

Later in the year, physicians urged Congress to find another way to avert the cuts before adjourning for the mid-term elections. But once again, Congress failed to act.

When Congress returned after the elections for a "lame-duck" session, physicians again pressed lawmakers to act. As was the case so many times before, Congress was unable to reach agreement and once again adjourned without fixing the problem.

Prospects for action in the new Congress

Administrative delays in publishing Medicare rates for 2003 postponed the 4.4% cut from January until March 1, giving Congress a small window of time to act. But when the new 108th Congress took office in January, prospects for quick action to halt the next round of cuts seemed bleak.

Many congressional observers predicted that competing priorities—and a lack of time—would preclude Congress from reaching agreement on legislation in time to avert the 4.4% cut. Many suggested that Congress would postpone action until lawmakers took up comprehensive Medicare reform later in the year.

Given such predictions and Congress' prior track record, one might expect physicians to conclude that they would gain nothing by sending yet another urgent round of communications to Congress. Yet many did respond, generating hundreds of additional letters and phone calls to Congress.

Less than a month after the new Congress took office, those efforts finally paid off. Congress passed legislation halting the 4.4% cut and replacing it with a positive 1.6% update. Moreover, the legislation passed by Congress and signed into law by President Bush will increase Medicare spending on physician services by $54 billion over the next 10 years, according to the Congressional Budget Office.

The law accomplishes these changes by clearly giving the Centers for Medicare and Medicaid Services (CMS) the legal authority to correct past miscalculations in the Medicare physician payment update. The CMS has admitted that such miscalculations cost physicians tens of billions of dollars, contributing to the 5.4% payment cut in 2002 and the 4.4% cut scheduled for March 1, 2003. But it had claimed that it could not correct mistakes without Congress granting it the explicit authority to do so.

Because the new law gives the CMS the authority to correct the mistakes, physician payment updates will be higher not only this year, but in 2004 and beyond. Medicare will spend $54 billion more than what it had planned—a particularly noteworthy achievement when the government has frozen or cut back spending on most other federal programs (except the military and homeland security department).

The power of persistent advocacy

Why did Congress finally act to avert the cuts and restore billions of dollars to doctors when it had failed so many times before? Thousands of doctors' persistent advocacy efforts finally got the message through to Congress.

All of the letters, phone calls and faxes that physicians sent over the past 14 months—the ones that Congress seemed to ignore—really did have an impact. After hearing from so many physicians so many times that the cuts would have a devastating impact on patients, members of Congress could no longer discount the seriousness of the problem—or the urgency of acting before March 1.

Most importantly, physicians never gave up in making their concerns known. They persisted, despite numerous setbacks. They made sure that their message was heard, at the time when it mattered most—in the closing days of the 107th Congress and the first days of the new Congress.

From mid-October though mid-February, ACP-ASIM members alone generated more than 5,500 phone calls, e-mails and faxes to Congress. Their patients produced hundreds of similar communications.

This phenomenal response from the physician community finally overcame the partisan gridlock that had doomed previous efforts to halt the cuts. By participating in the political process to an unprecedented degree—and being persistent despite repeated disappointments—physicians demonstrated the power that comes from determined advocacy on behalf of patients.

The role of organized medicine

This successful grassroots effort didn't happen spontaneously, however. In part it was the result of a disciplined campaign by organized medicine—ACP-ASIM, the AMA, and state and specialty societies—to harness the power of 500,000 doctors to pressure Congress to act.

ACP-ASIM, AMA and other members of the Medicare physician payment coalition met weekly in Washington. We designed and implemented a campaign that combined sophisticated grassroots advocacy, public relations and lobbying to make sure our efforts would succeed.

While Congress' decision is a huge win for doctors and patients, it represents the beginning—not the end—of the campaign for fair and adequate Medicare payments. The new law doesn't fix all of the flaws in the formula the government uses to determine future Medicare updates. As a result, physicians could still see more cuts in the future, although any cuts will be much lower than what would have occurred without the new law.

The new law also doesn't address geographic inequities in payments to doctors, and it doesn't ease "budget neutrality" rules that cut payments whenever the government adds new services to the Medicare physician fee schedule.

For many more months and years, ACP-ASIM and its members must continue persistent and determined advocacy to fix these and other problems with the Medicare payment formula.

By winning the first big battle over the Medicare cuts, however, we have demonstrated to Congress the potent power of thousands of concerned internists' grassroots advocacy efforts. We are prepared to use this power again, for as long as it takes to win the fight for adequate and fair payment for internists' services.

Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.


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