Same time, next year?

Medi­care pay fix passes with bi­par­ti­san sup­port

Modern Healthcare - - The Week In Healthcare - Andis Robeznieks

In a rare dis­play of bi­par­ti­san­ship, Congress quickly passed its sixth tem­po­rary fix of the Medi­care physi­cian pay­ment for­mula in 12 months, even as both sides ac­knowl­edged the leg­is­la­tion they just worked on to­gether re­ally did noth­ing to solve the prob­lem.

The Medi­care and Med­i­caid Ex­ten­ders Act of 2010, which would de­lay sched­uled cuts in physi­cian re­im­burse­ment to­tal­ing around 25%, passed the Se­nate unan­i­mously Dec. 8 and by a 490-2 vote in the House of Rep­re­sen­ta­tives on Dec. 9. It awaited Pres­i­dent Barack Obama’s sig­na­ture at dead­line.

The cost of de­lay­ing the cuts and ex­tend­ing the cur­rent pay­ment rates for 12 months is es­ti­mated at $14.9 bil­lion. The leg­is­la­tion in­tends to pay for this over a 10-year pe­riod by rais­ing caps on how much in­di­vid­u­als and fam­i­lies must re­turn if they re­ceive over­pay­ments from health­care af­ford­abil­ity tax cred­its.

Mem­bers of Congress have pledged to work to­gether next year to find a bet­ter way to pay doc­tors for treat­ing Medi­care pa­tients and to de­velop a for­mula that more ac­cu­rately re­flects the cost of that treat­ment.

Health­care or­ga­ni­za­tions and as­so­ci­a­tions said Congress was well aware of the prob­lem— the Med­i­cal Group Man­age­ment As­so­ci­a­tion said its mem­bers called, wrote or e-mailed their leg­is­la­tors 60,000 times with com­plaints about the sus­tain­able growth-rate for­mula used to cal­cu­late Medi­care pay­ment rates. But it was un­clear where the is­sue ranked on the list of pri­or­i­ties.

“It’s just al­ways there,” said Cindy Mor­ri­son, vice pres­i­dent of health pol­icy for Sioux Falls, S.D.-based San­ford Health. “It’s be­come a ‘core ask’ and it’s be­come part of al­most ev­ery con­ver­sa­tion you have with mem­bers of Congress.”

Al­though no one knows how the new Repub­li­can ma­jor­ity in the House will work with the Democra­tled Se­nate, last week’s House dis­cus­sion—led by Frank Pal­lone Jr. (DN.J.) and Joe Barton (R-Texas)—had a bi­par­ti­san air of col­le­gial­ity. Both, how­ever, had few kind words for the bill they were urg­ing their col­leagues to quickly ap­prove. “This is just an­other short-term fix,” Pal­lone said. But he added that the cur­rent mea­sure “is com­pletely paid for” and “re­ally not con­tro­ver­sial at all.”

Af­ter a two-month freeze passed Dec. 19, 2009, Congress this year has passed pay­ment­cut de­lays in March, April, June, Novem­ber and last week. Barton com­mit­ted to “sit down with stake­hold­ers and our friends on the soonto-be-mi­nor­ity side of the aisle” on a per­ma­nent so­lu­tion.

At a cost of an ad­di­tional $4.6 bil­lion, the bill also ex­tends sev­eral other Medi­care pro­grams. One of these, known as the “Medi­care work geo­graphic ad­just­ment floor,” drew the ire of Rep. Sam Farr (D-Calif.) who called that sec­tion of the bill “an abom­i­na­tion” and “spe­cial pork” from “cer­tain Mid­west sen­a­tors” that al­lows some physi­cians to be paid more than oth­ers. “It is plain un­fair to doc­tors in other states,” Farr said, though he voted to ap­prove the bill.

The op­pos­ing votes came from Reps. Brian Baird (D-Wash.) and Tom McClin­tock (RCalif.). Baird, a li­censed clin­i­cal psy­chol­o­gist who has worked in state and Vet­er­ans Af­fairs psy­chi­atric hos­pi­tals, ar­gued on his web­site that it’s un­fair that Florida re­ceives 28% more fund­ing per Medi­care pa­tient than Washington state.

The of­fi­cial sum­mary of the bill ex­plained that the geo­graphic ad­just­ment floor is in­tended to re­flect re­gional dif­fer­ences in costs of physi­cian work, prac­tice ex­pense and mal­prac­tice in­surance. Kent Moore, man­ager of health­care fi­nanc­ing and de­liv­ery sys­tems for the Amer­i­can Academy of Fam­ily Physi­cians, said Medi­care di­vides the coun­try into 89 lo­cal­i­ties whose bound­aries haven’t changed since 1997; the length of time since it was up­dated is the source of some com­plaints. But Moore said the AAFP is op­posed to all geo­graphic ad­just­ment ex­cept those driven by poli­cies seek­ing to pro­mote physi­cians prac­tic­ing in un­der­served ar­eas.

Mor­ri­son: The SGR has be­come a “core ask” with Congress.

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