After a plan to cut Medicare reimbursements was stalled in June, the issue is returning to the forefront.
Some background:
In June, Congress passed a six-month plan to prevent the 21 percent cut in Medicare reimbursements. The measure is retroactive to June 1. The New York Times reports:
"The legislation, known on Capitol Hill as the doc fix, was approved by the Senate last week without a roll-call vote after leaders of both parties agreed to separate it from a stalled package of tax changes and safety-net spending, including extended unemployment benefits."
The Times explains how the measure will be paid for:
"To get the short-term doc fix through the Senate, the cost of the measure was offset by changes in Medicare billing regulations, antifraud provisions and the tightening of some pension rules, eliminating Republican objections that it would put the federal government deeper into debt."
Before that move, doctors who treat Medicare patients were facing a 21 percent cut in the reimbursements they receive, a sharp drop that was to have taken effect June 1.
Adding fuel to the fire, while the House passed some temporary relief immediately before leaving for Memorial Day, the Senate declined to act, leaving the issue hanging over the week-long recess. After Congress returned June 7, a “doc fix” amendment was attached to the jobs bill, HR 4213, but the bill did not pass before the weekend. As Kaiser Health News reports, Congress debated a bill that would eliminate the cut in reimbursements. KHN has a roundup of reports from several news outlets about how the delay has created confusion for doctors and Medicare billing procedures.
The Center for Medicare and Medicare Services then delayed implementation and, on June 18, directed providers to begin processing claims from June 1 and late. At that time CMS said:
Congress continues to debate the elimination of the negative update that took effect June 1, 2010. The CMS is hopeful that Congressional action will be taken to avert the negative update. We continue to monitor Congressional actions, and if Congress changes the negative update that is currently in effect, we are prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.
Effect on patients
Critics say it could lead to doctors dropping or refusing to see Medicare patients, and patients having to hunt for new providers to pick up their care. The patients involved are seniors and military families covered by the Tricare health insurance program.
Opposing the cuts
The American Medical Association ran a series of expensive ads to put pressure on Congress. The organization launched what it calls the “Write Coat Rally,” in which doctors send signed white lab coats to members of Congress to protest the cuts.
Health journalists explain the cuts
AHCJ member Julie Rovner, of National Public Radio, explained the history of the Medicare cuts at a briefing on Health Policy co-sponsored by AHCJ. Listen to Rovner's explanation (MP3, 9 minutes), as well as some comments and ideas on how to cover the story from Kaiser Health News' Phil Galewitz and Noam Levey of the Los Angeles Times.
Stories to help with background:
- Renewed Threat Of Medicare Pay Cuts Leaves Doctors With 'Sense Of Fatigue,' Kaiser Health News
- Health on the Hill, Kaiser Health News
- Senate on Break, Medicare Fix Delayed Again, MedPageToday
- Physicians Seeing Fewer Medicare Patients Because of Low Pay and Threat of Cut, Medscape Medical News
- Congress keeps Medicare doctors waiting, CNN
- The Doctor Payment Follies, New York Times editorial
- What Health Law Didn't Fix: Medicare Doctor Pay, National Public Radio
- Congress Misses Deadline For Fixing Medicare Doc Pay – Again, National Public Radio
These organizations are campaigning for the cut to be reversed:
Members recommend these academic sources for a more sophisticated look at the complexity of Medicare payment formulas and their historic faults:
- Uwe Reinhardt, Ph.D., Princeton University: reinhard@princeton.edu or 609-258-5974
- Stuart H. Altman, PhD, Brandeis University: altman@brandeis.edu or 781-736-3803
- Michael Doonan, Ph.D., Brandeis University; executive director of the Massachusetts Health Policy Forum and director of the Council for Health Care Economics and Policy: doonan@brandeis.edu or 781-736-4831
AHCJ sources:
- What’s next? Reporting on Health Policy between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
Recent AHCJ conference panels:
Assessing Health Policy: Is there a looming doctor shortage? [Article about this panel]
• Kevin Barnett, Dr.P.H., M.C.P., senior investigator, Public Health Institute [PDF of presentation]
• David C. Goodman, M.D., M.S., professor of pediatrics and of health policy; director, Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice; Co-PI, Dartmouth Atlas of Healthcare [PDF of presentation]Impact of state budget cuts on health of the poor
• Alison Hirschel, elder law attorney, Michigan Poverty Law Program [PDF of presentation]
• Barbara Lyons, deputy director, Kaiser Commission for Medicaid and the Uninsured [PDF of presentation]
• Joy Johnson Wilson, health policy director/federal affairs counsel, National Conference of State Legislatures [PDF of presentation]
Other sources:
MedPAC, the Medicare Payment Advisory Commission, is a Congressional agency established to advise Congress on issues affecting the Medicare program.
Covering Health Issues, a sourcebook for reporters from the Alliance for Health Policy and the Robert Wood Johnson Foundation: Chapter 7 – Medicare (updated June 16, 2010)
Health Policy's Changes in Medicare , from Health Affairs and the Robert Wood Johnson Foundation: A three-page brief addressing changes in Medicare under Health Policy legislation (May 20, 2010)
Summary of Key Changes to Medicare in 2010 Health Policy Law (PDF), Kaiser Family Foundation: A nine-page document that summarizes the key Medicare provisions under the new Health Policy law; includes a Medicare implementation timeline (April 1, 2010)
Medicare Physician Payment Updates and the Sustainable Growth Rate System (PDF), Congressional Research Service; A 20-page review of the past, present and future of the numbers that determine reimbursement rates.
Estimated Sustainable Growth Rate and Conversion Factor, for Medicare Payments to Physicians in 2010 (PDF), CMS; Everything that went into the determination of the current reimbursement rate.
Major Medicare Savings Under Health Policy Legislation (PDF), American Medical Association: A short overview of how Medicare changes in the Health Policy legislation are projected to cut spending (April 7, 2010)
President Barack Obama discussed the issue during his weekly address on June 12.
[Transcript | Video: mp4 (86MB) | mp3 (3MB)]
