Printer-friendly format

Saying the nation faces “a potential Medicare meltdown,” the new president of the American Medical Association decried the U.S. Senate’s failure on June 26 to halt a cut in Medicare payments to doctors beginning July 1.

“Physicians across the country are outraged, because we go through this every year,” Nancy H. Nielsen, MD, told Medical News Inc. “Now, Congress makes us do it every six months. To come down to the wire like that, when it was very clear that the cuts needed to be stopped and physicians and Medicare beneficiaries needed to be treated fairly, to let this happen and to go home for the Fourth of July recess has just sent people over the edge.”

Earlier in June, the House overwhelmingly approved – by a veto-proof majority – legislation that would have delayed the scheduled 10.6 percent reduction in Medicare physician fees for 2008. The bill replaced the reduction with a rate freeze for the remainder of the year, and physicians would receive a 1.1 percent raise instead of an estimated five percent cut in 2009. But Senate Democrats fell one vote short of the 60 votes needed to gain cloture on the upper chamber’s companion legislation. Many Republicans and the White House objected to provisions in the bill that would decrease payments to Medicare Advantage plans, and President Bush threatened a veto. However, Senate Majority Leader Harry Reid (D-Nev.) pledged to bring the bill back to the Senate floor after the July 4 recess. “This is nothing short of putting politics above the seniors and people with disabilities who depend on Medicare,” he said after the vote.

Sen. Max Baucus (D-Mont.), chairman of the powerful Senate Finance Committee, sponsored the AMA-backed bill, dubbed the Medicare Improvements for Patients and Providers Act of 2008. He’s not giving up, either. According to his spokeswoman, Carol Guthrie, “He’ll come back and start fighting again for seniors as soon as the Senate is back in session. Of course, there will be work over the recess, I would guess. It was made very clear to all senators that the House was out. There was no opportunity to pass different legislation, that the doctors’ cut was looming on Tuesday (July 1) and that those who wanted to stop the cuts to Medicare needed to vote for this bill.”

On June 30, the day before the cuts were to take effect, the Bush administration effectively froze those cuts. Kevin Schweers, a spokesman for the Department of Health and Human Services, said the Centers for Medicare and Medicaid Services will not be processing doctors' Medicare claims for services delivered on or after July 1 until July 15 at the earliest to give Congress time to act when they return from recess.

Nielsen said the AMA is rallying its members and isn’t waiting until the holiday recess is over. “What’s clear is that physicians are, in fact, outraged, and they have begun to contact the people who voted ‘nay,’ both in the Senate and in the House. There were only a few in the House, but they’re going to be hearing from us as well, and we are going to put the pressure on, not only from physicians, but from everybody who’s on Medicare and everybody who cares about them. This is just not a political issue, and it’s become partisan. It’s not fair to hold Medicare recipients and their physicians as pawns in this partisan game. It’s just not fair, and we’re tired of it.”

Nielsen said the Medicare funding formula for physicians is “flawed,” and added, “Everybody knows it’s wrong. There’s not a member of Congress who doesn’t know it’s wrong.”

Paul H. Keckley certainly agrees that Medicare is in dire straits, and he sees this latest payment flap as a harbinger of more serious debate. “There is no scenario in which Medicare in its current payment structure is sustainable. Where I think this is going to take us is a couple of really, really interesting and potentially disruptive discussions,” he said. Keckley is executive director of the Deloitte Center for Health Solutions and boasts 30 years of experience in academic medicine and private-sector healthcare ventures.

Keckley expressed misgivings that, when all is said and done, physicians in reality will suffer a 10.6 percent slash in Medicare fees. “What is likely to happen will be a one to at most two percent increase,” he said. “The good news for providers is it’s not a 10 percent cut. The bad news for providers is that a one to two percent increase is still less than their operating cost increases, their cost of doing business. So, it does cut into the compensation of physicians and will certainly shrink somewhat the operating margin in practices.”

In short, Keckley predicted that the Senate will acquiesce. “In a political season, there is a lot of posturing that goes on. That’s the result of Medicare exceeding the thresholds that Congress enacted that put a force mechanism in place,” he said.

Keckley explained that a likely route for the Medicare of the future would be a “comparative effectiveness platform,” using evidence-based medicine and outcome studies to determine logical steps in patient care. “Which types of medications are working best and in what order, when is surgery essential as the next step versus others that are not surgical, when are certain types of diagnostic tests appropriate and when are they not?” he asked, noting that, according to the Congressional Budget Office, 30 percent of the nation’s healthcare spending could be reduced by applying comparative effectiveness to care.

Keckley added that physicians’ liability concerns would certainly be part of any comparative-effectiveness discussion. “What doctors would say is, ‘I do a lot of things because I’ll be sued if I don’t.’ Well, sometimes that’s true and sometimes it’s not, but it’s a valid discussion to have,” he said. “The second one is that we do a lot of things that we shouldn’t be doing, and that’s also something that needs to be addressed. Addressing both of those will be a pretty interesting policy discussion over the next really two years. I think it’s likely we’ll have a comparative effectiveness platform in place in the system before the presidential campaign in 2012.”

Yet another point of Medicare debate, Keckley predicted, will be how much enrollees themselves should be paying. “You’ll hear discussions around means testing,” he said. “If Medicare enrollees have annuities and big dividends coming in in addition to Social Security, should they be paying a higher premium than those who don’t?”

In closing, Keckley said, “In my career, this is the first time all sides of this discussion know that something has to happen. The difficult part of that is that there are going to be some losers.”




GRAPHIC



Check Up on Your Senator

How did you senator vote on the Medicare Improvements for Patients and Providers Act of 2008? Below are the votes of senators from the seven states where Medical News Inc. publishes.




Alabama: Sessions (R-AL), Nay Shelby (R-AL), Nay
Arkansas: Lincoln (D-AR), Yea Pryor (D-AR), Yea
Florida: Martinez (R-FL), Nay Nelson (D-FL), Yea
Louisiana: Landrieu (D-LA), Yea Vitter (R-LA), Nay
Mississippi: Cochran (R-MS), Nay Wicker (R-MS), Nay
North Carolina: Burr (R-NC), Nay Dole (R-NC), Yea
Tennessee: Alexander (R-TN), Nay Corker (R-TN), Nay

Tags:

None

Login and voice your opinion!