What Your Member of Congress Wants to Know

In recent weeks Congress has taken significant steps in moving legislation aimed at tackling the issue of surprise billing by passing legislation out of committees in both the House and Senate. Both bills would protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated by an in-network physician. However, neither bill holds health insurers accountable. Both bills would resolve payment disputes between physicians and insurers by setting out-of-network payments at the median amount each insurer pays for in-network care.

This is a serious flaw that needs to be fixed! The physician advocacy community may have opportunities with two other House committees to make further improvements on this and other elements in the legislation, but we can't leave anything to chance. That's why physician advocacy this recess is so important.

Our August Recess "Action Kit" on surprise billing has all the information you'll need to be an effective advocate on this issue!

After a 15 year fight to replace the flawed Sustainable Growth Rate (SGR) payment system in Medicare reimbursement rates, Congress finally acted, and passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. Since the enactment of MACRA, physician organizations have worked closely with both Congress and the Centers for Medicare & Medicaid Services (CMS) to promote a smooth implementation of key components of the law.

Unfortunately, it has become clear that further refinements are needed to improve the program and ensure physicians can be successful moving forward. During the first five years, the law had provided for modest payment increases, but payment rates still have not kept up with inflation. To make matters worse, the statute calls for zero percent payment update for years 2020-2025.

This problem is real and if Congress doesn't act, many physicians who see Medicare patients will be negatively affected.

This is where you come in, we're asking you to reach out to your members of Congress this August recess and urge them to support the following three ways to improve MACRA:
  • Implement positive payment adjustments for physicians to replace the payment freeze over the next six years;
  • Extend the Advanced Alternative Payment Models (APM) bonus payments for an additional six years, and;
  • Implement additional technical improvements to MACRA
Once again, we have posted an on-line “Action Kit” to give you the information you need to be an effective advocate on this issue.