Senate Finance Committee Republicans Outline Plans To Delay Medicare Physician Payment Cut
Senate Finance Committee Republicans, led by ranking member Chuck Grassley (R-Iowa), on Wednesday released an outline of legislation that would halt a 10.6% reduction in Medicare physician fees scheduled to go into effect July 1, among other provisions, CQ Today reports. The bill will compete with legislation outlined by committee Chair Max Baucus (D-Mont.), which also focuses on halting the payment reduction.The bills share some similarities, including creating electronic prescribing requirements, adding quality reporting programs and payment increases for physicians in underserved areas. In addition, both outlines do not contain provisions that Democrats and Republicans have disagreed on, including financial assistance for beneficiaries enrolled in the Medicare drug benefit. Both bills also would halt the payment reduction for 18 months.
However, Grassley's measure would provide physicians with a 1.1% increase next year, compared with a 0.5% increase proposed by Baucus. According to CQ Today, "While the difference seems small, it could mean hundreds of millions of dollars in reimbursements for physicians" (Armstrong [1], CQ Today, 6/4). Baucus said he plans to introduce his bill on Friday or Monday, while Grassley said he would introduce the competing bill shortly thereafter (Edney, CongressDaily, 6/4).
'Tactical Maneuver'?
Grassley's crafting of a similar bill "could represent a tactical maneuver ... to give moderate Republicans and those facing tough election battles a GOP-written version of the bill they can support," CQ Today reports (Armstrong [2], CQ Today, 6/4). Either bill would need 60 votes in the Senate to invoke cloture (Armstrong [1], CQ Today, 6/4). According to CongressDaily, attaining 60 votes could be difficult for Democrats. However, Baucus on Wednesday "returned ... to talk about compromise after he abandoned bipartisan negotiations two weeks ago," CongressDaily reports (CongressDaily, 6/4). "We'll come together," Baucus said, adding, "It makes much more sense for us to be together" (Armstrong [1], CQ Today, 6/4).
Funding 'Split'
According to CongressDaily, "Democrats and Republicans mainly are split over how to fund the entire package." Democrats want to make cuts to Medicare Advantage plans, while Republicans are only willing to cut indirect medical education payments in MA (CongressDaily, 6/4). Conservative Republicans and the White House say that private sector competition will ultimately reduce costs, but Democrats disagree, according to CQ Today. Sen. Kent Conrad (D-N.D.) said, "There have got to be savings out of Medicare Advantage. That is a runaway train." The bills are estimated to cost between $12 billion and $18 billion (Armstrong [2], CQ Today, 6/4). However, neither outline contains details about funding. The Bush administration opposes any cuts to MA and has threatened to veto legislation that includes them. Conrad said, "Frankly, the big problem is the White House" (Armstrong [1], CQ Today, 6/4).
According to CQ Today, last December, Democrats, led by Baucus, were faced with a similar issue. At that time, they advocated for a two-year halt on payment reductions, "paid for with deep cuts" to MA. Instead, a "more modest package" that halted physician payment reductions for six months eventually emerged. According to CQ Today, Conrad, Baucus and other legislators have refused to discuss the possibility of a similar result. However, lobbyists and other congressional observers say the current debate could again result in a short-term solution, giving "lawmakers nine months' or a year's worth of time to reconvene and try again under a new administration" (Armstrong [2], CQ Today, 6/4).
E-Prescribing Garners More Support
In related news, support for e-prescribing in Medicare is "gaining momentum in Congress" as both Baucus and Grassley included similar provisions in their outlines, the Wall Street Journal reports. According to the Journal, both plans "would take a carrot-and-stick approach" that would give physicians additional Medicare payments for adopting e-prescribing, then penalize physicians in subsequent years for failing to change over to the technology. E-prescribing efforts also have received backing by a broad lobbying coalition. An aide to Baucus said that the lawmaker "believes the Medicare program should be a leader in implementing widespread use of e-prescribing in doctors' offices all across the country." Grassley said that "e-prescribing makes a lot of sense wherever it's possible" (Wilde Mathews/Radnofsky, Wall Street Journal, 6/5).