The AHA today sent U.S. representatives and senators a letter highlighting its priorities and concerns as Congress works on end-of-the-year priorities and fiscal challenges facing the nation. AHA concerns include proposals to reduce payments for evaluation and management services provided in hospital outpatient departments, and reductions under consideration by the Medicare Payment Advisory Commission that would broaden this concept to additional, as yet unspecified services. Other concerns include proposals for additional across-the-board cuts to Medicare inpatient hospital rates through the use of retrospective coding adjustments for fiscal year 2010; for reductions in payments to hospitals for assistance to low-income Medicare beneficiaries (bad debt); and for reductions to Medicaid assessments. The letter also advocates for the extension of critical Medicare provisions for small or rural hospitals, and urges Congress to ensure that Medicare is included in any delay of the Budget Control Act sequester. "Hospitals' ability to maintain the kind of access to care their patients and communities expect is threatened by repeated ratcheting of payments for Medicare and Medicaid hospital services," the letter notes. "Additional cuts to Medicare and Medicaid funding for hospital services would mean longer wait times for care; fewer doctors, nurses and other caregivers; and less patient access to the latest treatments and technology."