Medicare Compliance & Reimbursement

Congress plays 'kick the can' with physicians' reimbursements.

Physicians could face a 12-percent Medicare cut in 2009 and a 13-percent cut in 2010, if one proposal goes through.
 
The House of Representatives and the Senate have come up with competing proposals for avoiding January's looming 5.1-percent cut to physicians' Medicare payments. But they mostly share the "kick the can down the road" approach to the problem, which would lead to ballooning pay cuts in a few years.

At least this time around, legislators are talking about kicking the can a little harder than in recent years. That means that instead of facing another cut this time next year, physicians would be safe for the next two or three years under most proposals.

Also, both the main House and Senate plans now guarantee the same, or a little better, reimbursement for all doctors next year. The House Energy & Commerce Committee would give physicians a 0.5-percent pay increase for each of the next three years. If physicians agreed to report quality information and take part in local utilization-management programs, they'd receive an extra 0.25-percent in 2008 and 2009, Chairman Joe Barton (R-TX) told a Sept. 28 hearing.

Meanwhile, the Senate Finance Committee unveiled a plan to give physicians a 0.5-percent pay increase in 2007 and 2008, according to Washington law firm Powers Pyles Sutter & Verville. Doctors would receive an extra 1.5-percent "bonus," starting in July 2007, for reporting quality information. But the Senate plan explicitly calls for a 12-percent cut to physician payments in 2009.

A Democratic plan, proposed by Rep. John Dingell (D-MI), would give all physicians a 2.7-percent pay increase and also protect Medicare beneficiaries from premium increases, according to Rep. Gene Green (R-TX).

Both Dingell and Rep. Charlie Norwood (R-GA) said at the Sept. 28 hearing that Medicare health maintenance organizations may have to cough up more money to cover the costs of fixing the physician payment system. "I want to see a permanent solution," said Norwood. He also came out against mandatory pay-for-performance.

Norwood wasn't the only Republican who expressed doubts about P4P. If Medicare starts paying doctors more for hitting quality targets, "what doctor in his right mind is going to go to a community where health literacy is low?" asked Rep. Michael Burgess (R-TX).

Barton said the current Sustainable Growth Rate system is "funny money anyway," and he's "100-percent committed to enacting legislation" to protect doctors from it.

Docs To Congress: Try Our Medical Home

Representatives of doctors' groups once again threatened that doctors would reduce the number of new, or even existing, Medicare patients they see if cuts go through. They said any P4P or quality programs should be phased in slowly, and Congress should reimburse doctors for the cost of adding health information technology. Also, doctors shouldn't be punished for providing more services in the name of quality, said Dirk Elston with the Alliance of Specialty Medicine.

Many doctors also urged Congress to launch a "patient-centered medical home" demonstration. This system would appoint one doctor, usually a primary care physician or internist, to manage the care for a chronically ill patient and coordinate care amongst all other health professionals.

The only skunk at the garden party was the AARP, which pointed to evidence of doctors billing Medicare excessively. The AARP doesn't support doing away with limits on physician spending because premiums and other costs will go up.

Both Republicans and Democrats promised that the 5.1-percent cut would not go into effect next year -- but then Congress adjourned for a long recess, leaving the issue for the "lame duck" session that starts Nov. 13.