Don't forget to call your Senators

[Mister Mxyzptlk]

Unless you've been living in a cave for the past few weeks you know that the Medicare Advantage plans successfully lobbied the Republicans to kill HR 6331, which would have staved off the 10.6% fee cut. In my state, Texas, the PAC for the Texas Medical Association pulled its support for John Cornyn's re-election bid.

There are many ways to contact your Senators. One is at http://capitol.aafp.org/aafp/home/.

I was told that advocating a boycott of Medicare Advantage plans could be an antitrust violation, so I am not telling anyone to do that, but if they decide that for themselves, well, who am I to stop them?

You should also feel free to copy this flyer that I am handing out in my waiting room:

Think before you join a Medicare Advantage Plan

Medicare Advantage plans have been touted as offering more "choices" to Medicare patients. What they don't tell you about is the hidden premium that we all pay through our tax dollars.

Medicare pays these insurance companies a 13% premium over what traditional Medicare costs. That comes to about $11,000,000,000 – eleven BILLION dollars of tax money going to subsidize insurance companies. And what do the insurance companies do with that extra money? Here's a recent news item:

"Humana, the second-biggest provider of government-funded medical benefits, reported a 13 percent increase in first-quarter profit on enrollment gains in U.S. Medicare health plans for the elderly."

In 2007, Humana's CEO Michael B. McCallister raked in $10,312,557 in total compensation according to the SEC. According to the AFL-CIO's calculation method, he raked in $10,874,383 in total 2007 compensation.

That is the equivalent of over half a million $20 co-pays.

And where does the 13% subsidy for these plans come from? It comes from you and I. We pay taxes, and the tax money is given to the Medicare Advantage plans, which also charge you a premium.

You are paying for your Medicare Advantage program TWICE – once with premiums, and a second time with your taxes.

Congress recently tried to stop the scheduled 10.6% Medicare fee cut that doctors are facing. The Medicare Advantage plans lobbied to kill it because the money to pay the doctors would come out of their feeding trough. My colleagues and I are therefore facing a 10.6% cut in revenue, effective July 1.

Since our costs are fixed and the average practice runs about 60% overhead, that translates to a 25% cut in take-home pay. Medicare has not raised fees for several years. Meanwhile, inflation has eroded the value of those fees and our cost of doing business has gone up. In effect we have already had a 15% pay cut just through inflation.

At some point – probably very soon – the system will break down. Doctors will be forced to close their practices. Those doctors who somehow survive will probably reduce how many Medicare patients they will see, and one of those people left out might be you. Senators Hutchison and Cornyn both voted to kill the bill. Think about that in the voting booth.

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Members don't see this ad.

 

[ampaphb]

Given that the President has said he will veto HR 6331 if the Senate passes it, is it your feeling there are veto-proof majorities in both Houses to over-ride the veto?

 

[Mister Mxyzptlk]

The Republicans are taking a lambasting over this and really can't afford to take much more. If Bush vetoes the bill it will be very damaging to his party in November.

If 600,000 doctors and their spouses - who tend to be politically conservative and have high voter turnouts - are angry they might feel some pain at the polls. Certainly they will feel the pain of lost campaign contributions as we have seen with TexPac. Cornyn is in a tight race and he can't really afford to lose votes.

When I receive solicitations in the mail for Republican campaigns I write on the enclosed form "Sorry, but with the Medicare fee cuts I can't afford to support you" and mail it back in the convenient SASE.

AARP is marshaling its 39,000,000 members on this, which could inflict a huge amount of damage. See http://bulletin.aarp.org/yourhealth/medicare/articles/senate_stalls_medicare.html Seniors have historically high voter turnout.

To override a veto requires a 2/3 majority. What we saw in the House is that the Republicans decided to ignore Bush's threats and vote for the bill in overwhelming numbers, 355-59.

The Senate vote was 58-40. Harry Reid voted against it for procedural purposes, so make it 59-39. We need 8 more Republican Senators to switch sides to override a veto.

And maybe John McCain will cast a vote this time. Coward. Obama and Clinton voted.

 

[radslooking]

The Republicans are taking a lambasting over this and really can't afford to take much more. If Bush vetoes the bill it will be very damaging to his party in November.

If 600,000 doctors and their spouses - who tend to be politically conservative and have high voter turnouts - are angry they might feel some pain at the polls. Certainly they will feel the pain of lost campaign contributions as we have seen with TexPac. Cornyn is in a tight race and he can't really afford to lose votes.

When I receive solicitations in the mail for Republican campaigns I write on the enclosed form "Sorry, but with the Medicare fee cuts I can't afford to support you" and mail it back in the convenient SASE.

AARP is marshaling its 39,000,000 members on this, which could inflict a huge amount of damage. See http://bulletin.aarp.org/yourhealth/medicare/articles/senate_stalls_medicare.html Seniors have historically high voter turnout.

To override a veto requires a 2/3 majority. What we saw in the House is that the Republicans decided to ignore Bush's threats and vote for the bill in overwhelming numbers, 355-59.

The Senate vote was 58-40. Harry Reid voted against it for procedural purposes, so make it 59-39. We need 8 more Republican Senators to switch sides to override a veto.

And maybe John McCain will cast a vote this time. Coward. Obama and Clinton voted.

so it passed big time in house. but only marginally in senate. whats the next step?

 

[ampaphb]

so it passed big time in house. but only marginally in senate. whats the next step?

Everything gorback said was factually accurate, but only if you understand the back story, so here goes:

1) The Senate has not voted ON THE BILL yet
2) The Senate voted 58-40 on the cloture motion, which would have closed debate on HR 6331, and brought it to the floor for a vote. You need 60 votes, so the motion was defeated.
3) Senator Reid voted against the motion in order to move for reconsideration when the Senate reconvenes on the 7th. Senator Kennedy was not present for the vote, so the Dems should have enough to bring the bill to the floor for a vote.

I spoke to David Vitter (my Senator here in Louisiana)'s director of legislative affairs yesterday for the rest of the story.

This issue has broken generally along party lines. From my simplistic vantage point, it comes down to this:

The Republicans want a "non-controversial" bill which does not include doing away with Part C (Medicare Advantage). Senator Vitter sent out a letter last week which said, in part that the current bill would "push more than 9,300 Louisiana seniors off of their current Medicare coverage." What that meant to me, on a cursory reading, was that they would lose their health insurance. What it actually means, however, is that they will lose their third party, insurance company provided, insurance, ff the insurance company chooses not to continue participating in Part C when the 15% incentive they currently receive is removed. If not, patients will STILL have the option of reverting back to traditional Medicare coverage, and thus will NOT be without insurance.


The Republicans proposed their "non-controversial bill" last Thursday, which did not include the Medicare Advantage cuts. The Democratic majority did not allow that bill to be brought to a vote. They believe that they can get 60 votes Monday to bring HR 6331 to the floor, and then get a majority to vote for the bill. The President has said he will veto the bill as currently constituted (Democrats will say that is the influence of the insurance companies, Republicans will insist they are offering their constituents the choice of multiple carriers). Whether the Dems can then muster a veto-proof majority in both houses remains to be seen.

In any event, CMS/the administration has placed a 10 business day hold on all cuts. There is ALSO a 14 day federally mandated hold period on top of that. (http://www.palmettogba.com/palmetto/palmetto.nsf/(News)/83122B423513F56A852574780067CB03?OpenDocument). Thus the first day any of us would see a reduced payment would not be till the end of the month.

To me, they are basically playing a political game of chicken with the cuts, but at the end of the day, one of the sides is going to blink. Which one? I am not smart enough to know that answer.

 

[Mister Mxyzptlk]

Well, now that the horse is out of the barn AMA is running a lot of TV and radio ads. As before, they are telling people to call their senators. Other than that I don't see much happening.

If you watch some of the physician forums online there are mixed feelings about dropping Medicare, going non-PAR, etc. Some docs want to send a message, others feel we shouldn't punish patients over this, others don't think they can survive w/o accepting Medicare.

The problem is that they are playing for a tie once again. We don't need to avert a cut, we need a raise, and it needs to be adjusted for inflation every year. If they just keep fees the same every year inflation will cut our income anyway.

My fear is that the non-cut non-raise approach will have the same result as all the previous times: it will calm down doctors just enough that any effort to fix SGR will lose steam. Once that happens AARP will stop backing us because the seniors will continue to have doctors.

In a way I sort of hope they don't avert the cut and there is total meltdown. It will be painful but probably the only way we can get the country (and the huge number of doctors who are being clueless slugs about this) to wake up and pay attention. Then we can leverage the disaster into true reform.

 

[radslooking]

Well, now that the horse is out of the barn AMA is running a lot of TV and radio ads. As before, they are telling people to call their senators. Other than that I don't see much happening.

If you watch some of the physician forums online there are mixed feelings about dropping Medicare, going non-PAR, etc. Some docs want to send a message, others feel we shouldn't punish patients over this, others don't think they can survive w/o accepting Medicare.

The problem is that they are playing for a tie once again. We don't need to avert a cut, we need a raise, and it needs to be adjusted for inflation every year. If they just keep fees the same every year inflation will cut our income anyway.

My fear is that the non-cut non-raise approach will have the same result as all the previous times: it will calm down doctors just enough that any effort to fix SGR will lose steam. Once that happens AARP will stop backing us because the seniors will continue to have doctors.

In a way I sort of hope they don't avert the cut and there is total meltdown. It will be painful but probably the only way we can get the country (and the huge number of doctors who are being clueless slugs about this) to wake up and pay attention. Then we can leverage the disaster into true reform.

interesting. you may be right about the last part. it is a sinking ship of sorts...perhaps better sooner than later.

 

[Mister Mxyzptlk]

Just in case you thought there wasn't any money for a fee increase:

"Medicare is proposing to increase payments for outpatient services by 3% to more than 4,000 hospitals and other facilities next year under the Outpatient Prospective Payment System. The CMS projects it will pay these providers $28.7 billion in calendar year 2009, compared with projected payments of $26.9 billion this year.

In addition, the CMS projects it will pay $3.9 billion to ambulatory surgery centers, an increase from the $3.5 billion these facilities were projected to receive in 2008."

http://www.modernphysician....

How about this?


CMS to pay 3.6% more to MA plans, drug deductible goes to $295 from $275 in 2009

http://seniorjournal.com/NE...

 

[Doctodd]

this is a cut and paste from an email i received from FSIPP(Florida Society.....) and it seems to explain some interesting things.




Lora L. Brown, MD, DABIPP

FSIPP President



FSIPP Secretary Comments on Proposed Physician Medicare Cuts!



Ms. Jaffe:



I appreciate your timely efforts in keeping the residents of Florida apprised of the proposed physicians' cuts through your article in Florida Health News. I might add that physicians receive a very small percentage of health care dollars. Below is a slide from a presentation given by Medicare. You can see that this pie chart demonstrates that physicians receive 23% of Medicare dollars. However, Medicare has adjusted this piece to take out ‘other suppliers' and the percentage to physicians then becomes 13%. This percentage includes expensive drugs that doctors provide in their offices such as Botox, Chemotheraputic Agents, Procrit and others. Consequently the percentage of Medicare Health Care Dollars that goes to physicians could be calculated at less than 10%.





Most of my Medicare patients complain about access to physicians. Further cuts will force more good doctors to leave Florida . The FMA has stated that doctors are leaving Florida , retiring early and seeking other opportunities. Unfortunately, it is the best doctors that are the first to go, secondary to the frustrations of increasing expenses and declining reimbursement, for some specialties it has become impossible to make ends meet. Most physicians work 12 hour days or more, take call and phone calls at night and perform rounds and consults on the weekends. Look at the pie chart. It is not the doctors that are sucking Medicare dollars. Further cuts to physician reimbursement will result in health care disaster in Florida in the coming years. These cuts are the result of a formula that uses the Sustained Growth Rate to determine reimbursement. Even a 5th grader can tell you that the figures do not run parallel, quite the contrary. Physicians and patients must call their representative to vote YES to HB 6331, which will put a hold on these cuts.





Deborah H. Tracy, MD, MBA

Florida Society of Interventional Pain Physicians, Secretary of the Board of Directors

Hernando County Medical Society, Pres-elect





______________________________________________________________________________________________________________________________________

Medicare gives doctors temporary reprieve on fee reductions

By Susan Jaffe
7/2/2008 © Florida Health News
WASHINGTON, D. C. — Doctors who treat Medicare patients were scheduled for a 10.6 percent cut in their fees beginning Tuesday, but now their bills won't be processed at all – until at least July 15.

The U. S. Centers for Medicare and Medicaid Services is putting a temporary freeze on processing to avoid having to cut payments. Florida doctors warned members of Congress last spring that they could be forced to turn away Medicare patients if their payments are cut when the cost of maintaining a practice is rising

The pay reduction took effect after the Senate narrowly rejected legislation the House overwhelmingly passed last week that would have delayed the cut and provided a small raise in 2009, among other things. The measure fell two votes short of the 60 needed for passage. Sen. Bill Nelson, a Democrat, supported it while Republican Sen. Mel Martinez did not.

When it returns next week from the July 4th holiday recess, Congress is expected to try again to erase the doctors' pay cut.

"I think CMS is trying to help us but the reality is it doesn't solve a thing," said Dr. Nancy Nielsen, president of the American Medical Association, the influential trade association that has started a six-state media blitz aimed at passing the bill.

"We're going to make sure that every member in the Senate understands they have to vote in a way that avoids a Medicare meltdown."

AARP members have also been working to persuade senators to support the bill.

"We're hoping that some senators will change their minds when they come back, because they are hearing from a lot of very unhappy constituents in their states," said David Sloane, AARP senior vice president for government relations and advocacy.

CMS took the action to minimize any disruption in delivery and payment of services to providers and Medicare beneficiaries, said spokesman Jeff Nelligan.

The agency notified Congress Monday that no claims sent on or after July 1 will be processed during the first 10 business days of the month. The notice also said that CMS can delay processing as long as electronically filed claims are paid between 14 and 30 days after they are submitted. To meet those required deadlines, Congress will have only eight calendar days to work out a solution that has eluded them for months.

"I hope we can get the votes we need," said Nelson's spokesman, Bryan Gulley, but he could not make any predictions.

Unless Congress intervenes, doctors also will see an additional 5.4 percent cut in their pay next year. Medicare officials announced the 2009 rates on Monday.

Both reductions are a result of the federal law that changed how Medicare calculates doctors' fees. But when the new method triggered a pay cut, Congress has erased it every time since 2003.

Although Martinez wants to avoid lowering doctors' fees, he did not vote for the bill last week because it included cuts in payments to companies that offer Medicare Advantage health plans, said his spokeswoman, Jessica Garcia. "Cutting one area in Medicare to help pay for another would have put 47,000 of Florida 's seniors at risk of losing their coverage," she said.

Martinez supports an alternate measure, one that would delay the doctors' pay cuts without taking money away from other areas of Medicare, and would not limit beneficiary access to private health plans, said Garcia.

President Bush has threatened to veto any bill that cuts money for private insurers. The legislation defeated last week would have used those savings to help pay for the higher doctors' fees.

Contact Florida Health News Washington correspondent Susan Jaffe at [email protected]

 

[Tenesma]

i am praying for a melt-down --- it is going to hurt a lot of people, but we need a melt-down for something to happen.

every medicare patient that I see, i ALWAYS tell them that I am thinking about dropping out of medicare.... I tell them that medicare is the worst of all payers, and I see medicare because I care about the elderly, but if they keep on cutting reimbursements i will be forced to opt-out.

surprisingly, ALL of the patients all agree and think that doctors should get paid more...

there needs to be a grass-roots approach about this...

 

[Tenesma]

by the way, i got 3 new fee schedules from 3 commercial payers this week stating that in light of medicare changes they are "adjusting" their fee schedule... in other words they are using this opportunity to down-grade my reimbursements and each one of them is matching medicare's cut of 10.5%... wow...

 

[mille125]

by the way, i got 3 new fee schedules from 3 commercial payers this week stating that in light of medicare changes they are "adjusting" their fee schedule... in other words they are using this opportunity to down-grade my reimbursements and each one of them is matching medicare's cut of 10.5%... wow...

that is tragic and will push all physicians into cash pay practices

 

[PMR 4 MSK]

that is tragic and will push all physicians into cash pay practices

All that will be real fun for the DEA targeting cash-only pain practices...

 

[Tenesma]

there is nothing wrong with cash-only pain practices - i know several run by very famous dudes and they are doing quite well, and practicing "relatively" ethically without being pill mills.

 

[Doctodd]

i think this happened yesterday....


> Senate Votes Reversal of Cuts in Medicare Doctor Fees

>

> The Senate voted final passage of legislation that would halt a 10.6 percent cut in physician Medicare reimbursements by reducing payments to private insurers instead.

>

> Senator Edward Kennedy returned to participate in the vote, his first appearance in the Senate since having surgery last month for brain cancer. The votes cast to take up the measure totaled 69, more than the two- thirds margin required to override President George W. Bush's threatened veto of the legislation. All 30 votes in opposition came from Republicans.

>

> Republicans and Democrats have been fighting over how to block the cut in fees that took effect July 1 for doctors who treat patients under Medicare, the U.S. health program for the elderly and disabled. Democrats say the money should come from reducing payments to private insurers that provide care through Medicare Advantage plans. Some Republicans objected, saying insurers would be forced to pare benefits to senior citizens. Aides to Bush have said they would urge him to veto the measure, although the House passed it by a veto- proof margin last month.

>

> Congratulations and thanks to all the ASIPP members who spent countless hours collecting signatures, sending letters and making calls. Without these efforts, this reprieve might not have occurred.

>

 

[Mister Mxyzptlk]

I never thought I'd live to see the day that I liked Ted Kennedy and hated the Republicans.

This is only half the battle. This is the part we get every year and I think it's safe to say we are all sick of it. It is not enough to not get a fee cut. We need to fix SGR once and for all and get decent annual inflation adjustments. Otherwise inflation will cut our fees as they have been doing.

My biggest fear is that this will appease enough doctors that the anger will cool off and the movement will lose steam. We have to keep pressing for reform and accept nothing less.

 

[ampaphb]

I never thought I'd live to see the day that I liked Ted Kennedy and hated the Republicans.

This is only half the battle. This is the part we get every year and I think it's safe to say we are all sick of it. It is not enough to not get a fee cut. We need to fix SGR once and for all and get decent annual inflation adjustments. Otherwise inflation will cut our fees as they have been doing.

My biggest fear is that this will appease enough doctors that the anger will cool off and the movement will lose steam. We have to keep pressing for reform and accept nothing less.

Would that it were that simple - physicians have 5 separate proposals depending on how you want to divide up the pie (ie. how your particular specialty could maximize its own reimbursement) - we need to get our own house in order, and develop one solution we can ALL agree on, before we can present a united front to CMS.

 

[radslooking]

So, basically Pubs were against it because it restricted choice for seniors. It sounds like perhaps they were trying to do the right thing and not let the cut go through, and still retain funding for Medicare Advantage, but the Dems "wouldn't let that proposal go to the floor" or whatever such nonsense. Who knows. All i know is we beat the geezers. Congratulations America.

 

[Mister Mxyzptlk]

The "geezers" were on our side. AARP with its 39 million members was pressing for this bill to pass. They knew that if the fee cut happened doctors would start dropping Medicare patients. If your overhead is 50%, a 10% pay cut costs you a 20% cut in take home pay. How many Medicare patients will be welcome under those circumstances?

The republicans are using terms like "choice" and "a competitive market", as if it's some noble thing the MA plans are doing.

I fail to see the competitive aspect of Medicare paying these companies an extra 13% to do the same job that CMS does. CMS does not have any CEOs making $10-20 million per year. They have no stockholders expecting to see rising profits every quarter (simply put, profits = money not spent on patient care, taxes, or business functions). No wonder the MA plans need a 13% crutch in order to compete.

I always thought republicans stood for less government spending and a free market. So why are they backing federal subsidies for insurance companies? What do they think they are - oil companies and giant farm complexes? Get them out of the federal feedbag.

Why not just keep that extra 13%, give the docs a raise, and give the seniors either more benefits or lower premiums?

And guess what? While we are in our annual beg-a-thon to fight fee cuts, MA plans are getting a 3.6% increase.

One more item: AARP runs a Medicare Advantage plan and they still backed this bill.

 

[Disciple]

there is nothing wrong with cash-only pain practices - i know several run by very famous dudes and they are doing quite well, and practicing "relatively" ethically without being pill mills.

Are these procedure only, or medication practices as well.


The mixture of opiates, cash pay and rich people just doesn't sit well with me.

 

[Disciple]

The "geezers" were on our side. AARP with its 39 million members was pressing for this bill to pass. They knew that if the fee cut happened doctors would start dropping Medicare patients. If your overhead is 50%, a 10% pay cut costs you a 20% cut in take home pay. How many Medicare patients will be welcome under those circumstances?

The republicans are using terms like "choice" and "a competitive market", as if it's some noble thing the MA plans are doing.

I fail to see the competitive aspect of Medicare paying these companies an extra 13% to do the same job that CMS does. CMS does not have any CEOs making $10-20 million per year. They have no stockholders expecting to see rising profits every quarter (simply put, profits = money not spent on patient care, taxes, or business functions). No wonder the MA plans need a 13% crutch in order to compete.

I always thought republicans stood for less government spending and a free market. So why are they backing federal subsidies for insurance companies? What do they think they are - oil companies and giant farm complexes? Get them out of the federal feedbag.

Why not just keep that extra 13%, give the docs a raise, and give the seniors either more benefits or lower premiums?

And guess what? While we are in our annual beg-a-thon to fight fee cuts, MA plans are getting a 3.6% increase.

One more item: AARP runs a Medicare Advantage plan and they still backed this bill.

Gorback,

Isn't this the point when you usually advise to get the F*** out of Dodge? er..Medicine?

 

[Aether2000]

1. ASIPP's participation in this yearly ritual is duely noted and much appreciated, however it is not rational for an organization of a few thousand doctors to take credit for the outcome that involved organizations a hundred times larger (AMA).
2. The Republicans stood in block and voted directly against physicians. As far as I am concerned, they are toast from now on.
3. We need a Congress with enough guts to bring parity between the hospital and physician reimbursement systems. Hospitals do not have to fight every year to stop 15% pay reductions from occurring. They get automatic increases every year....

 

[Mister Mxyzptlk]

Gorback,

Isn't this the point when you usually advise to get the F*** out of Dodge? er..Medicine?

At this point my only recommendation is to get out of the republican party.

 

[jsaul]

At this point my only recommendation is to get out of the republican party.

http://news.yahoo.com/s/nm/20080715/pl_nm/bush_medicare_dc_1


thanks george I am so sick of this man

 

[ampaphb]

http://news.yahoo.com/s/nm/20080715/pl_nm/bush_medicare_dc_1


thanks george I am so sick of this man

not to mention the 39 Republican Senators who sided with the administration, and the one Republican Presidential candidate who didn't feel the matter was important enough to bother to cast a vote. (of course 9 of them flipped on the subsequent vote, so they can now recite the Kerry-esque "I voted against the bill before I voted for it" - since most of them are up for re-election this year, I will leave it to you to decide what their motivation was).

Lastly, when you geet a lettter from the Republican spin machine trying to cast this as a matter of "choice", remember that that is code for putting the Insurance Companies interests ahead of those of physicians, At the end of the day, the Republican Party proved less concerned about you and your practice than they are about the insurance lobbyists and their future financial support of GOP candidates.