Physician groups seek quicker action on Medicare payment fix

Lobbyists for physician interests are growing increasingly anxious that Congress won’t act fast enough to prevent a 10 percent cut in doctors’ Medicare fees in 2008.

{mosads}Congressional aides insist that legislators will wrap up their work on the physician payment fix, and the contentious cuts to other Medicare expenditures needed to finance it, before the end of the year. Yet concern has been bubbling among physician lobbyists that action might be pushed back until early next year amid a crowded legislative calendar.

In particular, the continuing impasse over the State Children’s Health Insurance Program (SCHIP) has eaten into the time and attention that lawmakers and their aides would have dedicated to assembling what’s become a perennial Medicare package anchored by physician payment provisions.

Unless Congress acts, Medicare reimbursement fees to doctors will be cut by 10 percent on Jan. 1, 2008, under the current formula in place. Congress has tried for years to simplify the complicated payment system but has never agreed on a long-term fix.

Lobbyists say they had received assurances from lawmakers working on Medicare that they wouldn’t wait until 2008. Echoing those assurances, a Senate Finance Committee spokeswoman said that panel Chairman Max Baucus (D-Mont.) “is diligently working on completing robust Medicare legislation this year.”

The Finance Committee, however, has a lot left on its plate, from SCHIP to Medicare to the Alternative Minimum Tax.

Physician lobbyists say their concerns are justified by the rapidly diminishing number of days on the calendar this year and the concerted efforts of other healthcare interests at slowing or stopping the bill. Congress has failed once before to pass Medicare-payment legislation before the end of the year, in 2002.

Moreover, one physician lobbyist said, lobbyists haven’t seen anything in writing they can assess, even though the physician community has seen progress in the Senate and a commitment from Finance Committee Republicans to work with the majority to get something in place as talks have been taking place.

“It’s pretty uncertain at this point,” another physician lobbyist observed.

Negotiations in the Finance Committee on Medicare have advanced beyond staff-only meetings to face-to-face exchanges between panel members, but an agreement on a framework has been elusive. Committee Democrats and Republicans have not even settled on whether to proceed under regular order and hold a markup, lobbyists said.
Baucus has indicated that he wants to draft a two-year fix to the payment cuts, while ranking member Chuck Grassley (R-Iowa) has signaled that a less costly one-year solution would be more palatable to committee Republicans.

Finance Committee members also are divided on how to offset the fix, which could cost up to $20 billion. Congressional Democrats have been eager to make deeper cuts to private health insurance plans in Medicare Advantage but have met with stiff GOP resistance.

In addition, drafting a physician payment fix has been complicated by lobbying efforts on behalf of health insurers, oxygen-supply companies, nursing homes, power-wheelchair makers, kidney dialysis providers and others seeking to prevent their industries from being made to foot the bill.

“Everybody else would just as soon a package not be put together,” a physician lobbyist said, adding that these groups would be content to “run out the clock” to preserve their own Medicare funding.

Offsets also could be needed to cover a new Medicare bill other than a physician payment fix. The Senate Finance Committee is said to be weighing a substantial rural healthcare package, while both Baucus and Grassley have introduced legislation to enhance the Medicare prescription drug benefit.

For now, the House is waiting for the Senate to act. In August, the House passed a $20 billion physician payment fix as part of its combined SCHIP-Medicare bill. House Democratic aides indicated that the lower chamber doesn’t plan to revisit its Medicare legislation until it sees what the Senate devises.

These House Democratic aides maintained that final action on whatever the Medicare package is would be completed before Congress adjourns for the year. “We are committed to moving this forward and getting things done,” a House Democratic leadership aide said.

Like in previous years, a massive, end-of-session omnibus bill is considered the only realistic vehicle for moving a Medicare bill. “I expect it’s going to be the last vote on the last day,” a lobbyist said.