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Health Reform + Reducing Meciaire Reembursements

Posted by Phillipa on August 3, 2011, at 20:09:21

Seems they didn't cut medicaire but seem to be making the care impossible to get. Phillipa

From Medscape Medical News
Congress Passes Debt Deal; Could Reduce Medicare Payments
Robert Lowes

Authors and Disclosures

August 2, 2011 With a 74 to 26 vote by the Senate today, a contentious Congress finally passed a bill that both shrinks federal spending and raises the $14.3 trillion federal debt ceiling, just in time to beat an August 2 deadline and avert a catastrophic government default.

The House did its part yesterday by approving the bill 269-161 in a grudging bipartisan vote, with Democrats unhappy that envisioned spending cuts topping $2 trillion were not accompanied by any tax increases, which Republicans vehemently opposed. Next comes the expected signature of President Barack Obama, who had crafted the measure with congressional leaders.

The agreement may calm the financial markets by maintaining the credit worthiness of Uncle Sam, but it is troubling physicians and hospital executives, who could see their Medicare reimbursements trimmed in the process. Those potential cuts would come at a time when providers already face other major Medicare reductions.

Physicians, for example, are scheduled for a 29.5% decrease on January 1, 2012, unless Congress intervenes. The bill passed today does not include a "doc fix" to the Medicare reimbursement crisis, disappointing organized medicine, which had lobbied for such a provision.

"It looks like a double cross," Jack Lewin, MD, chief executive officer of the American College of Cardiology (ACC), told Medscape Medical News. "Im sure doctors will feel frustrated when they find out (about the possible debt-deal cuts)."

The debt legislation lays out a serpentine path to an additional Medicare pay cut. It calls for an initial $917 billion in savings over 10 years by capping federal discretionary spending, meaning that mandatory entitlement programs such as Medicare and Social Security are off-limits. That move would permit a $900 billion increase in the debt ceiling.

Then, a special 12-member congressional committee must identify at least another $1.5 trillion in savings that Congress must enact by December 23, allowing a second debt-ceiling hike of $1.5 trillion. If Congress fails to chop at least $1.2 trillion from the budget through 2013, then Obama would be limited to a corresponding increase in the debt ceiling.

At the same time, failure to hit the $1.2 trillion savings target would trigger automatic cuts in both discretionary and mandatory programs, including Medicare, from 2013 through 2021. However, the Medicare cut could not exceed 2% in any given year.

A summary of the bill posted on the White House Web site explains that potential Medicare cuts would be "limited to the provider side."

No One Knows Where Medicare Provider Cuts Would Fall

The provider side has responded sourly to the debt-reduction legislation, decrying the prospect of more rate cuts as opposed to reimbursement relief.

"Physicians feel like theyve already been thrown under the bus," Dr. Lewin said about the new law. "Now [Congress] is backing up the bus over them."

Roland Goertz, MD, president of the American Academy of Family Physicians (AAFP), warned in a statement released yesterday that lower Medicare pay would cause many physicians to either close their practices or limit the number of Medicare patients they treat reducing access to care either way.

"The debt ceiling/deficit reduction plan...offers a potentially false promise to patients," said Dr. Goertz. "It guarantees benefits but, by ignoring Medicare physician payment issues, it potentially denies the actual medical care those benefits cover."

Richard Umbdenstock, president and chief executive officer of the American Hospital Association (AHA), makes a similar argument in calling for Congress to exempt Medicare from the debt-deal budget ax. "Cuts to Medicare funding for hospital care," Umbdenstock said in a press release yesterday, "could overload emergency rooms, shut down trauma units and reduce patient access to the latest treatments."

What dials up the anxiety factor further is that the bill passed by Congress today does not specify how automatic cuts would be applied to Medicare. The program consists of 4 parts Part A for hospitals, Part B for physicians, Part C for Medicare managed-care plans, and Part D for prescription drugs. Kevin Burke, director of government relations for the AAFP, told Medscape Medical News that Congress could trim each part equally, or confine the cut to just 1 or 2 parts.

The potential for Medicare provider cuts is not lost on Wall Street. Stocks for a number of publicly traded healthcare companies, including those that operate hospitals, fell sharply this morning.

AMA Still Lobbying for Elusive Doc Fix

For physicians, the bill is a far cry from an earlier debt-reduction proposal in Congress that would have protected their Medicare reimbursement. That proposal, authored by the bipartisan "Gang of Six" senators, called for voiding the 29.5% pay cut set for 2012 and scrapping the sustainable growth rate formula that triggered it. The Gang of Six would have offset the cost of this doc fix priced at $298 billion over 10 years with unspecified savings in Medicare. The AHA worried that hospital reimbursement would be sacrificed for the sake of physicians.

Organized medicine has not given up petitioning Congress for the elusive doc fix, which almost became a part of the 2010 healthcare reform law before Democrats erased it because of its high cost. In a statement released yesterday, Peter Carmel, MD, president of the American Medical Association, said his group anticipates that the 12-member congressional committee charged with finding budget savings would address the Medicare reimbursement crisis.

"Everyone agrees that a 30% cut in payments to those who care for Medicare patients would hurt seniors' access to the healthcare they need and deserve," said Dr. Carmel.

Dr. Lewin said he had wished and hoped that Congress would incorporate a doc fix in a grand debt-reduction deal, but not expected it to actually happen, given the composition of the Republican-controlled House. With the advent of Tea Party Republicans, he said, there is less of a consensus in the House to enact a doc fix.

"The Tea Party doesnt want to spend any money," he said. "They dont care if doctors stop seeing patients."

He said the ACC would urge the the 12-member congressional committee on debt reduction to return to the problem of Medicare reimbursement. However, instead of trying to tame runaway costs through "futile" price-control solutions such as the sustainable growth rate formula, the committee ought to introduce reforms to reward physicians for quality and efficiency. Such an indirect approach to cost control would have a better chance of succeeding, Dr. Lewin said.

 

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URL: http://www.dr-bob.org/babble/20110728/msgs/992762.html