Ex­pect more health­care spend­ing bat­tles af­ter Elec­tion Day

Post-elec­tion bat­tles shap­ing over health­care costs

Modern Healthcare - - NEWS - Rich Daly and Jes­sica Zig­mond

READ The “Win­dow to Wash­ing­ton” blog at mod­ern­health­care.com/wash­ing­ton

De­spite a po­lit­i­cally frozen Congress, out­lines of post-elec­tion health­care bat­tles have be­gun to emerge. As provider, pa­tient and in­dus­try ad­vo­cates lob­bied law­mak­ers dur­ing Congress’ last week in ses­sion be­fore the Nov. 6 elec­tions, mem­bers of both cham­bers in­di­cated lit­tle de­sire to en­gage in se­ri­ous dis­cus­sions un­til the out­come of the pres­i­den­tial and con­gres­sional elec­tions are known.

The high­est-pro­file health­care fights will aim to avoid a 2% cut to Medi­care providers and in­sur­ers; a 27% cut in Medi­care physi­cian fees; and a slew of hospi­tal cuts. Those hospi­tal pro­vi­sions, known as “ex­ten­ders,” in­clude a pay­ment ad­just­ment for low-vol­ume hos­pi­tals, an in­crease in pay­ments for am­bu­lance ser­vices; and con­tin­ued fund­ing for chil­dren’s hos­pi­tals’ grad­u­ate med­i­cal ed­u­ca­tion.

“The im­pend­ing 2% se­quester and 27% SGR cut com­bined with more than a decade of es­sen­tially flat Medi­care pay­ments de­nies med­i­cal prac­tices the re­sources they need to mod­ern­ize Medi­care,” Dr. Jeremy Lazarus, pres­i­dent of the Amer­i­can Med­i­cal As­so­ci­a­tion, said in a state­ment.

Sen. Or­rin Hatch (R-Utah) said dur­ing a brief in­ter­view last week that “peo­ple aren’t to­gether yet” on re­solv­ing out­stand­ing health­care poli­cies. “It will have to be brought to a head; that’s for sure.”

The elec­tion’s out­come is expected to give the vic­to­ri­ous party the up­per hand dur­ing a post-elec­tion leg­isla­tive ses­sion, dur­ing which Congress will aim to re­solve out­stand­ing leg­isla­tive busi­ness. “It will be a po­lit­i­cal scrum of the high­est mag­ni­tude af­ter this elec­tion,” Rep. Ed Markey (D-Mass.) said in an in­ter­view.

In the cur­rent po­lit­i­cally un­cer­tain en­vi­ron­ment, one ex­pec­ta­tion is that Congress will ap­prove only a one-year re­prieve from any of the health­care cuts, in­stead of com­pre­hen­sively re­solv­ing any of them.

Rep. Michael Burgess (R-Texas), a physi­cian, told Mod­ern Health­care that he ex­pects pas­sage of a doc fix by year’s end and sug­gested a pos­si­ble du­ra­tion for the tem­po­rary patch. “I would think a year,” he said. “There’s no point in do­ing any­thing less than a year be­cause it just causes trou­ble.”

There also are in­di­ca­tions that the post­elec­tion ne­go­ti­a­tions will in­clude some

re­fight­ing of the bud­get bat­tle that oc­curred last year. Physi­cians and hos­pi­tals are wor­ried that Congress will patch the se­quester cuts trig­gered by the Bud­get Con­trol Act with other pol­icy tweaks that providers op­pose.

A pop­u­lar source for health­care spend­ing cuts among some mem­bers of Congress is the non­par­ti­san Medi­care Pay­ment Ad­vi­sory Com­mis­sion, which has of­fered a num­ber of ways to re­duce Medi­care spend­ing over the years. Among MedPAC cuts draw­ing par­tic­u­lar con­cern from hos­pi­tals is a pro­posal that Medi­care re­duce pay­ment rates for hospi­tal eval­u­a­tion and man­age­ment out­pa­tient of­fice vis­its to the amount pro­vided in physi­cians’ of­fices.

“This would re­duce the hospi­tal pay­ment by at least 71% for 10 of the most com­mon out­pa­tient hospi­tal ser­vices,” hospi­tal groups said in a Sept. 12 let­ter to mem­bers of Congress blast­ing the pro­posal.

Other providers are wor­ried that Congress again will cut fund­ing for ini­tia­tives launched by the Pa­tient Pro­tec­tion and Af­ford­able Care Act. For ex­am­ple, leg­is­la­tors cut $5 bil­lion from the law’s Preven­tion and Pub­lic Health Fund to help fund a leg­isla­tive pack­age in Fe­bru­ary 2012 that staved off the Medi­care physi­cian fee cut un­til Jan­uary 2013.

“Raid­ing (well­ness pro­grams) for just a pay­ment fix, which is just a short-term need, is just short­sighted,” said Dr. Glen Stream, pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians. Some provider ad­vo­cates also are con­cerned that bi­par­ti­san pro­pos­als to cut physi­cian train­ing funds are likely to re­turn in the lame-duck ne­go­ti­a­tions.

The con­tro­ver­sial sav­ings pro­pos­als—as well as other al­ter­na­tives fa­vored by providers—are de­signed to avoid adding to the fed­eral gov­ern­ment’s his­toric debt. But it re­mains highly un­cer­tain whether those op­tions are at­trac­tive and valu­able enough that Congress will be moved to pre­vent all of the sched­uled cuts to health­care pay­ments.

Sev­eral mem­bers of Congress asked about their health­care pri­or­i­ties as they pre­pared to leave town fo­cused on ex­pired and ex­pir­ing Medi­care hospi­tal pay­ment pro­vi­sions.

For in­stance, Sen. Max Bau­cus (D-Mont.), chair­man of the Fi­nance Com­mit­tee, which over­sees Medi­care, named the ex­ten­der pro­vi­sions as his lead­ing health­care pri­or­ity for the lame-duck ses­sion.

Sim­i­larly, Burgess said he thinks Congress will pass leg­is­la­tion to ex­tend those afore­men­tioned Medi­care pro­grams.

But the Texas Repub­li­can added that loom­ing Medi­care pay­ment cuts—set to take ef­fect Jan. 2 un­der the Bud­get Con­trol Act—could trig­ger im­me­di­ate roll­backs on those pay­ments (Sept. 17, p. 6). “I would en­cour­age peo­ple not to go out and spend that money when they get the ex­ten­ders passed be­cause we’re all go­ing to have to deal with it.”

Democrats hope to ad­dress all of the out­stand­ing health­care is­sues be­fore the end of the year, but the elec­tion re­sults will dic­tate what hap­pens, said Sen. Tom Harkin (D-Iowa), chair­man of the pow­er­ful Ap­pro­pri­a­tions La­bor, HHS, Ed­u­ca­tion and Re­lated Agen­cies Sub­com­mit­tee. The se­quester cuts might be held off “for a month or two, maybe,” Harkin told Mod­ern Health­care. “Ba­si­cally, I see this whole thing hap­pen­ing in Jan­uary or Fe­bru­ary, de­pend­ing on the out­come of the elec­tion.”


From left, Demo­cratic Sens. Harry Reid, Patty Mur­ray, Charles Schumer and Dick Durbin take ques­tions Sept. 20 on the Se­nate’s un­com­pleted work. As Congress ad­journs un­til af­ter the elec­tion, law­mak­ers say the re­sult will de­ter­mine how and when they han­dle loom­ing health­care cuts.

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