Medicare Compliance & Reimbursement

Plus: More than a third of doctors don't support the PQRI.

Lawmakers have made some changes to their State Children's Health Insurance Program (SCHIP) legislation, and it could end up hurting you. The new revision, called the Children's Health and Medicare Protection Act, "would increase tobacco taxes and cut Medicare payments to private Medicare Advantage (MA) plans," reports the Kaiser Network.

The bill would also reverse the cut in Medicare payments to providers and even provide "a modest increase in fees," reports the Kaiser Network. Additional provisions in the legislation include a simplified Medicare-application process and a relaxation in the current asset limits, more power to state insurance commissioners to regulate marketing of private MA plans, and payments to primary care physicians to coordinate traditional Medicare benes' care, reports Kaiser.

Not all lawmakers are on board, though. Some House Democrats "have expressed concern that cuts to [MA] plans could hurt members in their districts," according to CQ HealthBeat.

Although President Bush has said he will veto the bill, House Democrats may be able to overcome the presidential veto and get the legislation passed with their "strong intergenerational coalition," according to The New York Times.

The House Democrats say they expect to consider the bill next week, reports Kaiser.

In Other News...

· A Medicare pilot project to reward physician groups for meeting quality targets has paid off so far, says the Centers for Medicare & Medicaid Services (CMS). All 10 of the practices taking part in the Physician Group Practice Demonstration have met at least seven out of 10 benchmarks for diabetes care. And two groups have met all 10 benchmarks.

· But a new poll of 1,851 physicians commissioned by the Alliance for Specialty Medicine found that 36.3 percent of doctors don't support the Physician Quality Reporting Initiative (PQRI), with another 31.6 percent calling themselves "neutral." Less than a third were supportive or "very supportive." But 61.3 percent said they would take part in the PQRI. The vast majority of doctors--83.8 percent--said the PQRI should be delayed until CMS is sure it works.

· Almost a quarter of claims for negative-pressure wound therapy pumps didn't meet Medicare coverage criteria, according to new report from the HHS Office of Inspector General (OEI-02-05-00370). Medicare spent $21 million in 2004 on medically unnecessary wound therapy.