1. MSMA Council Meeting October 15, 2011

2. 30% SGR cut scheduled for January 1st Average $30,000 cut for each physician in Missouri Congress has intervened to prevent SGR cuts 12 times in the past decade Congress acknowledges cannot cut 30% - in past haven’t cut even 5% Medicare payments about 4% higher than 2002 vs expenses about 24% higher

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4. Access Is Threatened 20% of physicians overall, and 30% of primary care physicians already limiting number of Medicare recipients One in four Medicare patients struggling to find primary care physician 2012 election approaching

5. Numerous organizations propose fixing SGR as part of deficit reduction “Gang of Six” and Simpson-Bowles proposals reduce deficit by $4 trillion while fixing SGR

6. American public demands fiscal responsibility Congress has been keeping SGR deficit “off the books” Time for budget tricks and gimmicks is over

7. Linked debt limit increase to discretionary spending cuts Total savings: $917 billion/ 10 years Health care cuts and SGR provisions considered but not included Established Joint Select Committee on Deficit Reduction Charged with identifying additional savings of $1.2-$1.5 trillion/ 10 years Failure to pass triggers sequestration

8. Joint Committee Changes Game 12-member committee must find $1.2 – 1.5 trillion in deficit reduction measures by Nov. 23rd Congress to conduct up-down vote Dec. 23rd

9. Main event for remainder of 2011 AMA outlier in that we want Jt. Comm. To succeed/other groups prefer sequester Success requires focus on few priorities AMA currently focused on SGR and medical liability GME & multiple other physician issues on watch/intervention list

10. Opportunities: Size and scope can bear the burden Financial offsets still available Financial offsets more viable Escalating cost of short-term fixes argument gaining hold Simpson-Bowles deficit commission, Gang of 6, others have paved the way Procedural protections Challenges: View that SGR repeal represents spending increase not suited to this vehicle Targeted physician cuts may be included Other programs of interest may be cut (e.g., GME) Working close to Jan. deadline Other stakeholders have simple message/ more resources

11. Oct. 14, 2011 Standing committee recommendations due Nov. 23, 2011 Deadline for Joint Committee vote Dec. 9, 2011 Standing committee reports due on Joint Committee recommendations Dec. 23, 2011 Deadline for House and Senate votes, procedural protections end Jan. 1, 2012 29.5% Medicare physician payment cut takes effect Jan. 15, 2012 Joint Committee recommendations must be enacted to avoid sequestration Jan. 2, 2013 OMB orders sequestrations needed to make required cuts

12. 50% of savings achieved through cuts in Defense spending 50% achieved through cuts in other discretionary and mandatory programs Medicare cuts capped at 2% Social Security, Medicaid, VA, various retirement funds, and many other programs exempt from cuts Sequestration savings targets roughly $100 billion annually for 9 years Required savings could be less if Joint Committee agrees on cuts below the $1.2 billion threshold Cuts applied evenly across-the-board within each category (e.g., Defense, Medicare, other non-exempt programs)

13. Institutes 17% cut over 3 years to non-primary care physician payments, followed by 7-year freeze Calls for 10-year freeze on payments for primary care services performed by primary care physicians, and 17% payment cuts for all other services Would eliminate SGR, but... AMA strongly opposes proposal!

14. Congressional letter to Super Committee Rep Allyson Schwartz (D-PA) - sponsor Signed: Paul Broun (R-Ga.), Joe Heck (R-Nev.), Jim McDermott (D-Wash.) and Phil Roe (R- Tenn.). Didn’t sign: Dan Benishek (R-Mich.), Charles Boustany (R-La.), Larry Bucshon (R-Ind.), Michael Burgess (R-Texas), Bill Cassidy (R. La.) Scott DesJaris (R-Tenn.), John Fleming (R-La.), Phil Gingrey (R-Ga.) Andy Harris (R-Md.), Nan Hayworth (R-N.Y.), Ron Paul (R-Texas), and Tom Price (R-Ga.).

15. Super Committee proposal includes SGR repeal and Congress approves it Super Committee does not include SGR repeal or misses deadline Nov 23 - One month left to prevent 30% SGR cut on Jan. 1 st Super Committee includes SGR repeal, but Congress votes against their proposal $1.2 trillion in automatic cuts Includes 2% cut for all Medicare providers One week left to prevent 30% SGR cut on Jan. 1 st

16. A credible deficit reduction package should include full repeal of the SGR Recent bipartisan proposals have achieved over $4 trillion in savings while repealing the SGR Recent “SGR patches” have increased the size of future cuts & the cost of full repeal Medical liability reforms will lower health care costs by curbing meritless cases and reducing the practice of defensive medicine.

17. AMA to Congress: Repeal SGR Now! Sent joint letter to members of Super Committee Sent video to Congress, president and Administration

18. National Ad Campaign http://www.youtube.com/user/AmerMedicalAssn#p/u/5/IM0giJ1foOY

19. Use our template to email your Congressmen Use our toll-free number to call them Encourage your patients to get involved Access variety of campaign tools www.ama-assn.org/grassroots www.patientsactionnetwork.org 1-800-833-6354 www.ama-assn.org/go/medicarepayment Select “Medicare Physician Payment Advocacy Documents”

20. The AMA is working hard on your behalf. Great changes equal great opportunity. Medicine needs a strong voice – we need yours. Join the AMA !

21. David Barbe, MD MHA Secretary, AMA Board of Trustees Thank you ! !