Sunday, November 06, 2005

The Sights and Sounds of Sausage Making

This item from Wednesday received little fanfare while being thrown out into the great media mixing bowl this week, but it is not without impact. Medicare is planning to reduce fees to physicians by 4.4% in 2006, while increasing payments to hospitals by at least 3.7%. This has been in the works for some time, and reflects a long trend of decreasing pay to physicians caring for Medicare beneficiaries; I have related posts here and here.

I was waiting over the past few days for some sort of response from the American College of Surgeons and from Congress -- I subscribe to both the ACS's weekly "ACS NewsScope" e-mails and Senate Majority leader Bill Frist's "Weekly Health Report." The ACS gave it's standard line:

The College continues to urge Congress to pass legislation before the end of the year to stop the 4.4 percent cut from becoming effective. If Congress does act on this issue, it will most likely be tied to pay for performance. Fellows are strongly urged to contact their Representatives and Senators regarding this issue.
Interestingly, Senator Frist's e-mail missive said absolutely nothing that was not already included in the CMS press release (emphasis mine):
Wednesday, the Centers for Medicare and Medicaid Services announced a final payment rule for physicians and hospital outpatient departments. The final rule specifies that, based on the yearly update formula, payment rates per service for physicians’ services will be reduced by 4.4 percent for 2006 unless Congress acts. A provision to address the cut was included in the Senate Budget Reconciliation Bill. The rule also includes other policies affecting Medicare Part B services such as extending the glaucoma screening benefit and providing supplemental payments to federally qualified health centers (FQHCs) that contract with Medicare Advantage (MA) plans.

“The existing law calls for a decrease in payment rates for physicians in response to continued rapid increases in use of services and spending growth, and Medicare does not have the authority to change this,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “The current system is not sustainable, and the payment reduction offers further proof that we must move to a payment system that ensures adequate payments to physicians, but also supports high quality and efficient health care services. We want to continue to work with Congress toward a payment system that is more sustainable. In this rule, we continue to refine payment rates to reflect current medical practice, while doing all we can under current law to support physicians’ efforts to provide greater quality and efficiency of care for Medicare beneficiaries.”
It appears that the Senate did indeed pass the budget reconciliation bill (S 1932) late Thursday, but given the tortured process involved with getting bills through, I have been unable to determine if the above-mentioned provision was left intact --- a series of proposed amendments were voted down. Most of the attention given to this bill in the press has been centered around its provision to allow drilling in ANWR and its intended $35 billion deficit reduction. We may need to wait for a few days to determine if we will truly see a significant reduction in Medicare payments to physicians. Payment reduction will significantly impact the ability of Medicare recipients in many areas (mine included) to access primary care physicians....driving them to the ED for care....driving up health care costs.

Hopefully, someone with inside knowledge can read the tea leaves and let the rest of us know what is in the final bill.