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ASCO, ASH: ‘Fiscal cliff’ legislation only provides temporary reprieve
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Federal legislation designed to avert the “fiscal cliff” delayed by 1 year a 26.5% cut to Medicare physician reimbursements and offers short-term protection for biomedical research funding.
However, the measure comes up well short of the permanent solutions needed to ensure patients continue to receive high-quality, high-value care, according to key physician leaders.
The legislation provides “a momentary reprieve from political brinksmanship,” but major policy challenges still lay ahead, said Clifford A. Hudis, MD, president-elect of ASCO.
“Unfortunately, the triple threat of sequestration cuts to cancer research, physician reimbursement and drug review oversight — jeopardizing oncologists’ ability to care for their patients — is only temporarily averted, with the new 113th Congress having just 2 months to resolve the mandatory spending cuts,” Hudis, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center, said in a press release.
H.R. 8, the Job Protection and Recession Prevention Act of 2012, amends the Economic Growth and Tax Relief Reconciliation Act of 2001.
It increases the income tax rate for workers earning more than $400,000 annually and extends unemployment benefits. The measure also delays for 2 months a series of automatic spending cuts that were scheduled to take effect Jan. 1.
The Senate approved the bill on Dec. 31 by a margin of 89-8. A day later, the House passed the measure by a 257-167 vote. President Obama signed the bill into law on Jan. 3.
The Medicare physician payment cut stems from the sustainable growth rate (SGR), a key factor in annual Medicare payment updates designed to limit spending. The American Medical Association and other medical societies have called for the SGR to be altered or repealed.
Congress has voted several times in recent years to forestall the Medicare physician payment cut. Over the next several months, it must take action to eliminate the recurring problem, said Jeremy A. Lazarus, MD, president of the AMA.
“This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients,” Lazarus said in a statement. “This instability stalls progress in moving Medicare toward new health care delivery models that can improve value for patients through better care coordination. Physicians want to work with Congress to move past this ongoing crisis and toward a Medicare program that ensures access to care and the best health outcomes for patients and a stable, rewarding practice environment for physicians.”
Janis A. Abkowitz, MD, president of ASH, also issued a statement calling for long-term solutions.
“While the legislation passed protects the country from going over a fiscal cliff for the time being, the society is keenly aware that NIH and other non-defense discretionary programs are not safeguarded from future cuts, and there is not a permanent solution for the flawed physician payment formula,” Abkowitz said.
“Given this uncertain outlook, ASH will continue to urge lawmakers to provide balanced deficit reduction that does not further cut discretionary programs like NIH,” she said. “The society will educate Congress about the value of biomedical research so that all members of the new 113th Congress understand that this is not the time to defund science and that discoveries made possible by investments in NIH generate incredible returns in the form of lives and jobs and importantly help secure America’s position as a global economic force.”
Perspective
Back to TopMaurie Markman, MD
The impact of the pending Medicare cuts on the ability of oncologists to provide optimal patient care simply cannot be overstated. It is critical that the public and their representatives understand that as cancer becomes a more ‘chronic disease process’ rather than a single episode of care our societal strategy to fund care must change to reflect this reality. As a society we must decide what we want: A future characterized by improved survival and quality-of-life for patients with cancer, or the status-quo. And I suspect we all know the answer to this question.Perspective
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Jeffrey R. Starke, MD
The federal government did the only thing it seems to be good at these days, which is crisis management. In fact, virtually none of the problems were solved, just the inevitable was delayed. It punted on raising the debt ceiling and sequestration, and did nothing to fundamentally restructure what is a broken financial system. If nothing else changes, the effect on health care will be catastrophic.
In the short run, Medicare reimbursements to physicians were not cut by 27%. However, none of the financial reforms and restructuring that are needed to make the Affordable Care Act truly transformational to American health care were addressed. My analogy is with quality and safety in health care. For decades, we in health care just put bandages on safety problems to get through the day. Now, we are trying to restructure systems and processes to fundamentally improve the system, avoid the problems, and make it as safe as possible. Our government needs to do the same thing, restructuring the financial system and processes to avoid fiscal cliffs and debt ceilings while ensuring that essential services are maintained.
The problem will not be solved by the expression of extreme “principles” on either side of US political philosophy, but must be solved by compromise and avoidance of the fear to try a new approach. As with medicine, true change in fiscal policy will require courage and leadership, two qualities that have been almost totally lacking in Washington and state capitals all over the country.
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