Psychiatr News January 18, 2008
Volume 43, Number 2, page 1
© 2008 American Psychiatric Association
Congress Votes Six-Month Delay in Threatened Medicare Cut
Mark Moran
APA is among the physician groups that are relieved to see the payment
revision but is demanding that Congress provide a permanent fix to the
Medicare payment formula.
As in past years, Congress stepped in at the last minute to avert a
deep cut in overall physician payment under the Medicare program—at
least for a while.
On December 18, just days before the congressional Christmas break, the
Senate Finance Committee approved a 0.5 percent increase in overall payment to
last until June 30. That's a six-month reprieve from an impending 10.1 percent
overall cut originally proposed by the federal Centers for Medicaid and
Medicare Services (CMS).
The measure (S 2499) was part of a package that included reauthorization of
the State Children's Health Insurance Program (see
Final SCHIP Renewal Bill Fails to Expand Access). The legislation
was approved by the full Senate later the same day and by the House of
Representatives the next day.
At press time, the measure was expected to be signed by President George
Bush.
The proposed cut was the largest yet by CMS, the result of the payment
formula for Medicare requiring the program to be budget neutral from year to
year despite increases in volume. In past years, CMS has proposed significant
cuts in physician payment in Medicare, only to have Congress intervene and
provide a payment increase at the last minute.
According to the measure passed by Congress last month, the original 10.1
percent cut will go into effect on July 1. APA's Department of Government
Relations and Office of Healthcare Systems and Financing cautioned that
payments to individual psychiatrists may still go up or down depending on
individual practice and coding patterns.
On December 18, 2007, Sen. Charles Grassley (R-Iowa), ranking minority
member of the Finance Committee, said in a statement released after the
committee's action that he and other lawmakers had hoped to approve a two-year
increase in physician reimbursement, but had been unable to find mechanisms to
pay for it.
And he said the six-month period would give the committee time to revisit
the issue of Medicare payment later in 2008.
"When discussions began to solve this problem, I was in favor of a
two-year update," Grassley said. "Unfortunately, for a variety of
complex reasons we are now here with a much more limited package. This is a
disappointment for many of us. So the purpose of moving forward with a
six-month package now is to provide the opportunity for the Finance Committee
to address these priorities [in 2008]."
The physician payment fix and other measures in the bill will be paid for
by cuts in a "Medicare stabilization fund," a fund established
under the Medicare prescription drug program to attract preferred-provider
organizations to underserved areas; cuts in payments to hospitals for
inpatient rehabilitation services; reductions in physician payment for drugs
administered by physicians in their office; and adjustments in other Medicare
provisions.
Physician groups, including APA, welcomed the payment revision but lamented
that the original CMS proposal to cut payments will go into effect in just six
months. And once again they called on Congress to provide a permanent fix to
the Medicare payment formula, and especially its so-called sustainable growth
rate component.
Edward Langston, M.D., chair of the AMA Board of Trustees, in a statement
released after the Senate action hailed Grassley and other senators who had
helped forge the agreement.
But, he added, "We are disappointed that the Senate could only agree
on a six-month action because it creates great uncertainty for Medicare
patients and physicians. We strongly urge Congress to break the tradition of
short-term interventions that are not fully funded and fail to chart a course
for replacing a flawed payment formula that is a barrier to improving quality
and access to care for seniors."
In another Medicare-related issue, Nicholas Meyers, director of APA's
Department of Government Relations, said that CMS was planning to extend the
deadline for physicians who wish to change their participation status, and he
added that it was possible that Congress would next year extend the update
beyond the June 1 deadline.
"The six-month 'reprieve' is welcome news," he told
Psychiatric News. "We are advised that CMS will extend the
December 31, 2007, deadline for physicians who wish to change their
participation or nonparticipation status under Medicare for 45 days (until
mid-February), and if, as expected, Congress extends the 0.5 percent positive
update from July 1 through December 31, it is possible that CMS will provide
another opportunity for physicians to change status."
A summary of the bill passed by the Senate Finance Committee is
posted at
<www.senate.gov/~finance/sitepages/leg/LEG%202007/Leg%20110%20121807med&schip.pdf>.
Related Article:
-
Final SCHIP Renewal Bill Fails to Expand Access
- Rich Daly
Psychiatr News 2008 43: 10-34.
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