When it comes to fixing Medicare's physician payment formula in the House, the livin' is easy.
The Senate, not so much.
The physician lobby faces an uphill battle in the Senate after the House's uneventful passage of a bill that aims to prevent a scheduled 21.2% rate decrease to Medicare physicians next year by reforming the way doctors are paid under the program.
Physicians have been waiting for a long time for Congress to fix Medicare's sustainable growth-rate, or SGR, formula, which is based on the economy's health, and has produced results that would have led to payment cuts to physicians every year since 2003. Congress has stepped in each time to enact a temporary fix so that doctors wouldn't experience additional reductions to their Medicare payments.
Wary of a failed Senate vote on a similar bill to eliminate the SGR last month, the American Medical Association has vowed to redouble its efforts in the Senate to make sure a permanent fix becomes law.
“There is widespread agreement in the Senate that the current formula is flawed and should be replaced. We will vigorously make the case to senators that this is the right time for the right solution to the Medicare physician payment problem that threatens seniors' access to care and choice of physician,” J. James Rohack, M.D., president of the AMA, says in an e-mailed statement.
Now that the House has passed its legislation, the Senate has several options on how it may proceed on the SGR fix, says Patrick Smith, senior vice president of government affairs with the Medical Group Management Association. Senators could take up what the House approved, or reconsider its own bill, which failed in the Senate last month, and then negotiate with the House on the respective versions, Smith said.
If the Senate ever decided to insert an SGR fix into broader healthcare reform, it would have to find a way to pay for it, taking into account the pressure to keep costs down in that $848 billion bill.
The next steps for medical organizations are to have members contact their senators, “making it quite clear that the No. 1 priority is a permanent repeal of the SGR. There should not be a short-term adjustment,” Smith says.
Rep. Michael Burgess, M.D., of Texas, the one Republican who voted for the House bill, doesn't think the legislation stands much of a chance. “I think it's very unlikely … the bill will ever become law, since the Senate has already soundly rejected a similar plan,” Burgess says in a written statement. Burgess says his vote was largely symbolic, to support U.S. doctors.
GOP rhetoric over “fiscal responsibility” colored the SGR reform debate last week, with Republicans arguing the bill would add $200 billion to the federal deficit and ramp up beneficiary premiums. The SGR fix, under a budget agreement made by lawmakers earlier this year became exempt from so-called “pay-go” requirements, meaning its $210 billion price tag would be absorbed into the budget baseline.
Physician lobbyists countered that Congress needed to address the problem this year or suffer much greater costs in the future.
Holding off on a permanent solution with these “Band-Aid” approaches will continue to make the problem more expensive to fix, Nancy Nielsen, M.D., the AMA's immediate past president, told reporters during a teleconference last week. In 2005, the cost to permanently replace the SGR was $48 billion. Since then, it has grown to $210 billion, she said.
Failing to achieve a Medicare physician payment fix also calls into question Congress' ability to produce any type of healthcare reform, Nielsen and other physicians have contended.
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