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Congress should vote to pay doctors fairly.Medicare.

May 29, 2010

WASHINGTON — Senators will leave for Memorial Day recess without voting to stall a 21% cut in Medicare reimbursements to physicians.

The cut will go into effect next Tuesday, but contractors for the Centers for Medicare and Medicaid Services (CMS) have been instructed to hold claims for the first 10 days of June in anticipation of a retroactive fix when lawmakers return June 7.

In previous years, Congress has typically passed measures to delay for one year the physician payment cuts mandated by the sustainable growth rate (SGR). But Congress seems to have abandoned that approach in favor of a slew of very short-term delays. That means Congress grapples with delaying the cuts nearly every month, and passing such bills is never easy.

This is the third time since February that Congress has left for recess without passing a bill to stall the cut, but the reimbursement reduction has never actually gone into effect because lawmakers have twice voted this year to retroactively delay the cut when they return from vacation.

The latest proposed “fix” would put off until 2011 cuts in Medicare pay to physicians. The provision is contained in a broader bill — called the American Jobs and Closing Tax Loopholes Act of 2010 — that would reinstate expired tax breaks and a number of social programs.

Democratic lawmakers spent the past two weeks trying to secure enough votes to pass the so-called “tax extenders” bill and to save doctors from the June 1 cuts. In the days leading up Memorial Day, the bill was scaled back several times in an attempt to win support from fiscally conservative Democrats, whose votes are crucial.

Last week, Democrats were touting a five-year fix, but that plan was quickly deemed too pricey and was dropped in favor of a plan to stall the cuts for 3.5 years, until 2014. Then, as vacation week loomed, Democrats presented a tax extenders package that contained a 19-month “doc fix.” The total package would cost $80 billion, $23 billion of which would go toward Medicare payments to doctors, according to the Congressional Budget Office.

But in the end, cutting off billions from the original $100 billion bill wasn’t enough to win the votes of the necessary numbers of senators, and lawmakers left for a week-long vacation without voting on the measure.

Regan LaChapelle, a spokeswoman for Senate Majority Leader Harry Reid (D-Nev.), denied that failure to secure enough votes was the issue and blamed the slowness of the House to vote on the measure as the reason for the Senate’s inaction.

The House finally passed the SGR measure Friday afternoon — by a vote of 245 to 171 — after separating the doctor payment issue from the tax-extenders package and voting on the two bills separately.

But senators have essentially left town, making a vote in that chamber impossible considering that every Democrat in the Senate along with at least one Republican would have to vote in favor.The Senate will take up the bill with a 19-month delay — or some form of it — when lawmakers return on June 7, and will likely pass a retroactive delay along with it, LaChapelle said.

The lack of action normally would have meant that Medicare would have to begin reimbursing doctors 21% less starting June 1, except that CMS stepped in to save doctors from the cut.

Late Thursday, CMS said it would instruct its contractors to hold claims for medical services delivered on the first 10 days of June. The hold shouldn’t effect cash flow because claims aren’t paid any sooner than 14 days after they’re received.

This will be the third time this year that CMS has held claims to save doctors from actually feeling the steep cut. In both prior cases — in February and then again in March — Congress left for recess without voting to stall the cut.

Doctors are predictably outraged that lawmakers have, yet again, returned to their home states without voting on the SGR measure.

“The Senate has turned its back on seniors, and America’s physicians are outraged that Congress has deserted patients by failing to address this year’s Medicare cut before the June 1 deadline,” said American Medical Association president James Rohack, MD, in a statement. “Senators are more interested in heading home for the holiday than in preventing a Medicare meltdown for seniors.”

The president of the American College of Cardiology (ACC), Jack Lewin, MD, called the current situation “the worst-case scenario.”

“Congress leaves town without even a Band-Aid, therefore allowing substantial cuts to heart patients’ care to go through on June 1,” he said. “Medicare shouldn’t be a political football held captive to election year politics.”

Onlookers have charged that lawmakers in both political parties who are up for election this year don’t want to go on record in support of such an expensive bill because they fear their vote will be used against them.

“Internists and their patients are rightly angered by the fact that too many of their elected representatives and senators chose to put politics ahead of ensuring that seniors and military families have access to healthcare,” said J. Fred Ralston, Jr., MD, president of the American College of Physicians.

Lori Heim, MD, president of the American Academy of Family Physicians, said many members of her group don’t have the money to cover even a short-term reduction in payments for treating Medicare beneficiaries, which make up about one-quarter of family doctors’ patients.

“Many of our members, especially in rural and medically underserved areas, are in small practices that have no margin to cover even a temporary reduction of this magnitude,” Heim said in a statement. “Congressional inaction has crippled family physicians’ ability to continue caring for this vulnerable group of Americans and threatens the health security of hundreds of thousands of elderly and disabled patients.”

Marsha McKay, DO, a family doctor in Twain Harte, Calif., said she hasn’t taken any new Medicare patients for two years in anticipation of the day Congress would fail to block the cuts.

If this cut becomes permanent, McKay estimates she’d be paying $23 for each visit with a Medicare patient.

“I am in solo practice and there is no safety net so that I can subsidize their visits with other patients,” she said in an e-mail. “If Congress continues to threaten physicians each year with this cut, something bad is going to happen. Doctors will finally wake up and get meaningfully involved in the process or we will opt out of these programs altogether.”

Another physician, Scott Fields, MD, a professor in family medicine at Oregon Health and Science University, in Portland, said he doesn’t know what his practice will do if the cut is permanent.

“What I can say is that the easiest thing to do would be to immediately close to new Medicare patients,” he said. “This would maintain our commitment to established patients but limit our risk.”


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