Finance Committee staffers meet with stakeholders about Medicare physician cuts

Jun 3 2008

Democratic staffers for the Senate Finance Committee on Monday met with physician specialty groups to discuss a legislative package proposed by committee Chair Max Baucus (D-Mont.) that would halt a scheduled 10.6% cut to Medicare physicians' payments and institute a 0.5% increase in the payments for next year, CongressDaily reports.

The meeting comes after some of the same groups met with the committee's Republican staffers on Friday, according to a Senate aide. According to CongressDaily, the groups are expected to meet with Baucus in Washington, D.C., on Thursday. Baucus is hoping to bring the package to the floor next week, CongressDaily reports.

Other provisions in the package reportedly include:

• Extending and encouraging the use of a Medicare physician quality reporting initiative, including a 1.5% bonus for physicians who report certain quality measures to Medicare, and extending the program until 2011 and increasing the bonuses to 2%;
• Linking electronic prescribing to Medicare reimbursements by providing physicians who use the technology with a 2% bonus beginning in 2009, which would be scaled back to 0.5% in 2013, while reducing by 1% payments to physicians who do not use e-prescribing by 2011 and by 2% in 2013 and beyond;
• Certifying imaging facilities performing advanced services by 2012 (Edney, CongressDaily, 6/3). Uncertified facilities would no longer qualify for Medicare payments for the technical aspects of performing imaging services;
• Requiring HHS to provide physicians with confidential feedback about "resource use" -- how efficiently they use tests and procedures;
• Requiring HHS to submit to Congress a plan for switching to "value-based" physician payments that take into account quality and efficiency of care;
• Authorizing the HHS secretary to lengthen a three-year "demonstration project" to provide Medicare patients in eight states with "medical homes";
• Extending a mechanism under which patients can be exempted from current Medicare payment caps for rehabilitation services;
• Reversing a Medicare payment rule to allow anesthesiologists to receive 100% of payment for cases involving the teaching of residents or student-nurse anesthetists;
• Authorizing Medicare payments for medical professionals to educate patients with kidney disease about their condition;
• Requiring Medicare coverage of certain cardiac and pulmonary rehabilitation programs (Reichard, CQ HealthBeat, 6/2); and
• Extending increased reimbursement rates to physicians in areas with relatively few physicians, with a new bonus payment for primary care physicians in those areas (Armstrong, CQ Today, 6/2).

Parties Coming Together

CongressDaily reports that a source indicated that the physician-related provisions Republicans unveiled Friday are "close to those Democrats are seeking." According to CongressDaily, both parties are advocating an 18-month halt on reductions to physician payments. However, the parties disagree over how it should be funded. Republicans are seeking indirect payment reductions to private Medicare Advantage medical education, while Democrats are advocating for across-the-board payment reductions to MA plans.

Although the Bush administration wants legislation passed by June 16, "stakeholders widely believe any final language will have to be bipartisan to make it through the Senate" (CongressDaily, 6/3). According to CQ Today, "In the end ... some sort of compromise is almost certain" (CQ Today, 6/2). According to CongressDaily, stakeholders and Democratic staffers are "awaiting [Congressional Budget Office] scores to push a final product" (CongressDaily, 6/3). According to CQ Today, the overall package is expected to cost between $12 billion and $18 billion. Democratic aides said the physician pay portion of the package would cost about $7.5 billion to $9 billion, according to meeting attendee and American Osteopathic Association Director Shawn Martin. A physician lobbyist who attended the meeting said Baucus would pay for the proposal in part with revisions to Medicare's private fee-for-service plans (CQ Today, 6/2).