Medi­care cuts loom ...

... but some health­care lead­ers in Congress in dark

Modern Healthcare - - COVER STORY - Rich Daly

Hos­pi­tals are ramp­ing up ef­forts to fore­stall a 2% across-the-board cut to Medi­care pay for providers next year, even as some con­gres­sional health­care lead­ers re­main un­aware that it’s com­ing.

The au­to­matic $1.2 tril­lion in cuts from Medi­care and most non-en­ti­tle­ment pro­grams were re­quired by the Bud­get Con­trol Act of 2011 af­ter Congress failed to agree on spe­cific deficit-re­duc­tion steps by last Novem­ber. It will cut $317 bil­lion from Medi­care providers and Medi­care Ad­van­tage in­sur­ance plans, ac­cord­ing to the Bi­par­ti­san Pol­icy Cen­ter. The so-called se­quester will be­gin Feb. 1, ac­cord­ing to the Con­gres­sional Bud­get Of­fice.

The Medi­care cuts gen­er­ated vo­cal op­po­si­tion from provider ad­vo­cates and their con­gres­sional sup­port­ers be­fore they were for­mally trig­gered at the end of 2011 (Nov. 28, 2011, p. 6). But much of the de­bate in Congress this year around avoid­ing the ef­fects of the se­quester has fo­cused al­most ex­clu­sively on the na­tional se­cu­rity and eco­nomic im­pacts of its De­fense Depart­ment cuts.

Sev­eral mem­bers of Congress have sought to change that, in­clud­ing Sen. Tom Harkin (D-Iowa), chair­man of the Health,

Ed­u­ca­tion, La­bor and Pen­sions Com­mit­tee. He is­sued a re­port last week de­tail­ing the range of non-De­fense im­pacts. That re­port spec­i­fied some health­care-re­lated cuts, such as the $2.4 bil­lion elim­i­nated from the Na­tional In­sti­tutes of Health, but omit­ted any ref­er­ence to the sig­nif­i­cant Medi­care provider cuts, and for good rea­son.

“Medi­care can’t be se­questered be­cause Medi­care is not a dis­cre­tionary ac­count,” Harkin said when Mod­ern Health­care asked him about the provider cuts. Harkin was not alone in his view. “I think Medi­care is ex­empt from the se­quester,” Sen. Bar­bara Mikul­ski (D-Md.), an­other se­nior mem­ber of the HELP Com­mit­tee, said in a July 25 in­ter­view.

Such dis­cor­dant views about the Medi­care im­pacts of the se­quester il­lus­trate the ex­tent of the chal­lenge that providers and their ad­vo­cates face in ed­u­cat­ing mem­bers of Congress about the im­pacts of those cuts.

“That’s frus­trat­ing to hear,” Mag­gie Ele­hwany, vice pres­i­dent of gov­ern­ment af­fairs and pol­icy at the Na­tional Ru­ral Health As­so­ci­a­tion, said when told about those re­sponses from law­mak­ers. “This was some­thing that was fairly well-pub­li­cized at the time it went through, and we have re­ally tried to keep get­ting the word out.”

That outreach ef­fort to mem­bers of Congress con­tin­ues to ramp up as rep­re­sen­ta­tives of about 60 hos­pi­tals and health sys­tems plan to lobby mem­bers of Congress early this week. Ru­ral hospi­tal lead­ers plan to fol­low up with in­vi­ta­tions for mem­bers of Congress to visit their fa­cil­i­ties dur­ing the up­com­ing Au­gust re­cess.

“It’s one thing to hear this will im­pact ru­ral hos­pi­tals, but it’s an­other thing to see these fa­cil­i­ties and the chal­lenges they are fac­ing,” Ele­hwany said.

The Amer­i­can Hospi­tal As­so­ci­a­tion also ex­pects its mem­bers to fo­cus on the im­pacts of the se­quester at their fa­cil­i­ties dur­ing their an­nual con­gres­sional ad­vo­cacy event in Septem­ber.

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