Friday, June 25, 2010


After months of dithering, delaying, denying, and defaulting on a decision, Congress ended up . . . doing as little as possible to address the Medicare physician pay cut problem.

Last night the House of Representatives acceded to the Senate’s bill to provide physicians with a 2.2% update retroactive to June 1. This respite, though, lasts only through the end of November, when physicians and patients will again face another double-digit cut. And if the past is prologue, a lame-duck Congress then will wait until the very last minute to enact another short-term patch, or worse yet, allow the cut to go into effect on December 1 and then pass some kind of retroactive adjustment.

You know that the situation has gotten ridiculously bad when the President says this about the bill he just signed into law:

"Kicking these cuts down the road just isn't an adequate solution."

and when Speaker Pelosi (D-CA) calls it "inadequate" and a "great disappointment"
and the best that any had to say about it was this from SFC ranking member Charles Grassley (R-IA):

"This action was critically needed so there’s no disruption in services for anyone."

But it's too late.

As I told Katherine Hobson, who writes for the Wall Street Journal blog,
"the damage has [already] been done, resulting in a growing lack of confidence in the [government's] ability to deliver on promises to Medicare patients."

Yeah, I am fed up with the situation, just as I am sure most doctors are. What is especially galling this time around is that Congress had multiple opportunities over the past year-and-a-half to advance a permanent solution, but ended up just kicking the can.

The Senate could have passed an ACP-supported bill, approved by the House of Representatives in November, which would have completely repealed the SGR and replaced it with a better update framework to allow higher updates for all services and an additional bump for evaluation and management and preventive service visits. It did not.

The Senate could have passed an amendment, offered last year by Senator Debbie Stabenow (D-MI), to eliminate all of the accumulated SGR cuts. It did not.

Just a few weeks ago, the House and Senate leadership appeared to have settled on a plan, developed in consultation with ACP, to provide five years of positive and stable updates and to begin to move to a better payment update framework, based on the bill passed by the House in November. Lacking the votes they needed, they scaled it back to three-and-a-half years, still with a higher bump for primary care and preventive services. This too, was dropped because they didn’t have the votes. The House then passed a 19-month reprieve and the Senate a six-month reprieve (neither of which moved policy to a better payment framework).

Then, for four days this week, the chambers remained at an impasse, until the House acceded last night to the Senate’s six-month patch.


What can be done now? Well, physicians need to hold their elected representative and Senators accountable when Congress returns to their states and districts looking for votes over the Independence Day holiday recess. Tell them how Medicare’s unreliability and instability is affecting you and your patients. Get them to commit to doing whatever is needed to enact a long-term solution that Democrats and Republicans alike will support. Don’t let them get away with blaming someone else.

As ACP President Fred Ralston said on Monday, "physicians and patients don't want to hear that it is the Democrats' fault, or the Republicans', or the President's, or the Senate's, or the House's. They don't want to hear politicians claim that they are for repealing the SGR, as they withhold their vote from any practical plan to achieve repeal . . . They want to hear that members of Congress, on a bicameral and bipartisan basis, have agreed on a long‐term solution to replace the unworkable SGR."

Get them to commit to doing that, and maybe we won’t be sticking seniors with another turkey of a bill come November.

Today’s question: How will you be holding your own member of Congress accountable for the Medicare SGR debacle?


Steve Lucas said...

Doctors should take this time to reevaluate their practices and determine if a non Medicare/Medicaid model may in fact give them a better opportunity at staying in front line medicine.

The political realities are that we may have a lame duck Congress. Currently we see a political class more interested in their self interest and agenda than representing the desires of the population as a whole. Compromise and discussion has been left behind in a race to demean and one up the opposition. It appears we are dealing with children and all of the adults have left for a saner place.

This administration has spared no time in inserting itself into the automotive, insurance, banking, finance, and medical fields. We have also seen the “smart guy” approach to governing where the focus on one issue is negated by an action by another agency.

Arizona passes an immigration law in an attempt to deal with drugs and gangs and it is leaked that the administration is planning an amnesty for all illegal aliens. As a pilot and aircraft owner we are use to dealing with the FAA. The general aviation community was shocked when the FCC ruled our emergency locator beacons were no longer legal after a long negotiation to with the FAA to allow their continued use, understand the frequency would no longer be monitored. The list goes on.

Doctors need to look at where they will be Jan. 1. Higher income and investment taxes are a certainty. A cash or retainer model may better suit their patients and practice style. I am sure there are other models I am not aware of that will also provide this needed service along with a livable income.

Don’t waste this opportunity.

Steve Lucas

kevinh76 said...

It seems like congress doesn't even listen to the ACP and the AMA. Yes, you talk. They don't listen or act on your advice and requests. Maybe it's time to stand with your membership rather than congress and encourage all ACP members to opt out of Medicare and all private insurance contracts. Then, we would have some leverage for change.

Unknown said...

I went to D.C. on Wednesday to lobby with Community Oncology Alliance. I was appalled at the LACK of physician attendance. One doctor told me the he could not afford to go. Why not; he was not paid by CMS for over 3 weeks.
Every member of Congress with whom I met said virtually the same things after they were finished finger pointing.
1. Where is your representation on The Hll?
2. Why have you doctors put up with this for so long?
3. Getting doctors to cooperate is like herding cats.
Boy are the congressmen using all of those facts to our detriment.

However as a dumb multiple boarded physician who has been in private practice for over 25 years
I had a few very simple ideas. I expressed 2 of these to several Representatives that did catch their attention.
1. Mailbox stuff local retirement communities with the facts - not political spins. Seniors will talk to their relatives in other states and counties. Seniors are the largest voting block in the country; this idea had a definite impact on 4 Congressmen who are up for re election.
2.For once have the medical societies work together - exclude the AMA since we all know that their loyalities lie with the CPT coding. Have ASH work with AAO, ASCO, ACP, ACS with one goal- fix the SGR. Don't dither about their other needs. This is the only issue.
3. Show citizens the reimbursement at 100% and with the cutback. All the Congressmen were again appalled at rates for a CABG, "initial office visit/consultation." As lawyers they know their hourly rates. They really have no idea about our reimbursement.
4. Take a day off in October - before the elections.Put the problem on the front page of a paper ( it is no where to be seen now ) By taking a day off we will force the issue. Force them to take a stand during the campaign; force them to vote before a December quamire with a lame duck Congress.
5. Opt out of Medicare. Flood your regional carrier with the forms. You have 90 days to reverse your decision but it will send a message to seniors, CMS, and Congress.
We have already worked for less than free for 1 month. The next go round will be worse with a Congress filled with members who lost their elections.
Consider having physician work cohesively.Consider a day off from Medicare patients. We would never put a bandaide on an abscess. But we are letting Congress bleed us dry.