Part B Insider (Multispecialty) Coding Alert

Now that the U.S. House of Representatives has shot down Sen. Charles Grassley's (R-Iowa) provision to equalize payments between rural and urban physicians, its fate has become tied to that of President Bush's overall Medicare reform plan, which pushes patients into private insurance plans in exchange for more benefits.

Many doubt that the Bush plan can pass both houses of bill would be doomed as well. "I don't know if we're going to get a Medicare bill," said Iowa's other senator, Democrat Tom Harkin, who cosponsored Grassley's amendment and has long pushed for geographic equity in Medicare, according to CQ Today.

Grassley concurred: Medicare reform legislation is "legitimately a more appropriate place to deal with this," but there may be a Democrat filibuster. And if there is, "I don't have a vehicle to get this to the president," he acknowledged.

Moreover, there's plenty of purely intra-Republican controversy regarding how much and what kind of reform should accompany adding a drug benefit to Medicare. The House, which has passed bills incorporating drug-only coverage the last couple of years, has shown little enthusiasm for the administration's desire to push beneficiaries into private plans that would offer drugs as part of an integrated benefit package.

"The next time you talk to the White House guys," one GOP aide says, ask "What's the goal? Is it just to get people into private plans, or is it to save money, or is it to deliver care most efficiently?" If the goal is "just to say they're now in Aetna, rather than in Medicare, I don't think we've achieved anything." If, on the other hand, the White House goal is to provide efficient care, then "there's ways to work with it," the staffer continues, but also expresses deep skepticism about getting private plans into rural areas at an affordable cost.