Practitioners influence Congressional fight about Medicare pay cuts

Physicians persisted and received an 18-month reprieve from cuts in Medicare reimbursement.

Issue: October 2008

A scheduled reduction in Medicare reimbursements that has been the subject of controversy among many health care professionals has also been a contentious issue in Washington.

The legislative conflict revolved around a formula-derived 10.6% cut in Medicare reimbursement that was scheduled to take effect on July 1 and to occur automatically. Physicians groups and advocates have lobbied successfully in recent years to achieve annual reprieves from the scheduled adjustments, which many practitioners feel is vital to keeping pace with rising operational costs.

Fight in congress

A grassroots campaign from organizations like the American College of Cardiology helped initiate a flurry of lobbying activity. The pressure on Congress resulted in another temporary reprieve from the reimbursement cut that will last for 18 months. In addition, the amended bill grants a 0.1% adjustment for 2008, a 1.1% adjustment for 2009 and extension of payments to rural providers.

The original bill, H.R. 6331, was introduced to block the 10.6% cut and passed in the House of Representatives by a vote of 355 to 59 on June 24. It failed to reach the Senate floor after losing a procedural voice vote, blocked by a group of Republican senators who took issue with the bill’s proposed cuts to private health care plans in the Medicare Advantage program. After receiving pressure from the ACC and other professional medical organizations, several senators reversed their votes, brought the bill to the floor and passed it. President Bush vetoed the legislation, citing the reasons that stalled the bill in the Senate, but the veto was overridden by Congress on July 15.

In a July 9 e-mail to colleagues and participants in the grassroots effort, W. Douglas Weaver, MD, president of the ACC, wrote that “during June and July, members sent more than 4,000 e-mails and made 900 phone calls to senators alone.” Weaver also wrote that the “phone calls, visits and letters to lawmakers kept up the pressure and shifted the balance of support necessary to move this legislation forward.”

Financial pressure on physicians

Although physicians are subject to the adjustments of the strategic growth rate, hospitals, insurance companies and other entities are not. This has frustrated many practitioners who feel they are not being treated fairly.

“We feel unfairly singled out that our payment is tied to the gross domestic product; hospitals are not subject to this,” Samuel L. Wann, MD, chairman of the department of cardiovascular medicine at Wisconsin Heart Hospital in Wauwatosa, said. “Every year we come back asking for a reprieve from this pay cut, and it is disappointing to me that we are still asking this question.”

Although the predicament practitioners face from the structural adjustments in the Medicare payment system has not abated, the fight in Congress has afforded the issue visibility that Wann thinks may help the effort in the long term.

“Many of my colleagues are unhappy about this, and a small number are actually glad it is so bad because they see this as a call to arms for the medical community,” Wann, editor of Cardiology Today’s Practice Management and Quality Care section, said. “It has already pushed many cardiologists and specialty groups to employment in hospitals, and even if they give us the 10.6%, our office costs have been rising faster and the remuneration has been going down, making it increasingly difficult to run a free-standing office.”

Preparing for changes

Professional societies like the ACC are attempting to help practitioners prepare for the coming changes in payment and regulations on imaging. Weaver sees the shift in focus from quantity to quality.

“I am hoping that we will have some payment reform linked to quality health care, and the ACC has placed quality at the center of our mission during the past several years for this reason,” Weaver said. “The ACC has done this by publishing practice guidelines, appropriateness criteria and maintaining registries so that we are ready to help doctors to make the change from being paid based on quantity and complexity to a system that considers the quality of health care that is given.”

Weaver also sees the coming reform as an opportunity to realign and streamline some health information operations and increase the quality of the patient’s experience. The implementation of standardized electronic medical records, for example, is cited as a necessary change.

“The entire electronic medical record effort in this country is far from perfect and there has not been standardization of terms and of the way things should be done,” Weaver, a member of the Cardiology Today editorial board, said. “The recent bill in Congress also gave an incentive for doctors to do e-prescribing. I have no doubt that e-prescribing has prevented drug errors that could otherwise occur as well as the opportunity to review potential drug interactions before the physician signs the prescription.”

Changes in the Medicare payment structure are predicted to begin with legislative reform in Congress. However, the anticipated systemic reform is not likely to change before a new presidential administration is installed.

“For the next 18 months, really not a lot will change with the way that payment works,” Weaver said. – by Eric Raible