Senate Rejects "Doc Fix"

[tungsten87]

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ruh roh

http://www.medscape.com/viewarticle/723782?sssdmh=dm1.622479&src=nl_newsalert&uac=142788CN

 

[WVUPharm2007]

Oh God...now I have to deal with droves of pissy physicians.

Oh...wait...I'm unemployed. Haha, all of you have to deal with pissy physicians and I don't.

 

[rxlea]

Saw that in my work e-mail box.

 

[Praziquantel86]

This has just made pharmacists a more valuable commodity. With all the NPs that are going to step up and fill the void for Medicare patients, we're going to be seeing a lot more horrendously thought out prescriptions.

In all honesty though, this is awful. Primary-care physicians simply won't be able to afford to take Medicare patients and still meet their overheads. The elderly population has a hard enough time finding a primary doc as it is, and this will make it almost impossible for them. The only people who end up benefiting from this are the government and independently practicing mid-levels.

 

[PharmaTope]

ruh roh

http://www.medscape.com/viewarticle/723782?sssdmh=dm1.622479&src=nl_newsalert&uac=142788CN

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[tungsten87]

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get a medscape account. its free.

 

[rxlea]

Senate Rejects "Doc Fix," Medicare Fees Cut 21%

June 17, 2010 — In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21% reduction in Medicare reimbursement to physicians and other health providers.
A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.
The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30, rather than for the 19 months mandated by the earlier bill.
It still was not enough, however, to win over the 60 senators needed to end debate on the issue under Senate rules. Fifty-six senators voted in favor, with 40 opposed. Opponents argued that the overall measure was not offset by spending cuts and added too much to the deficit.
The pay cut for physicians took effect June 1, but the Center for Medicare and Medicaid Services (CMS) had held up June claims through today, anticipating that Congress would stop the reduction retroactively.
Because the "doc fix" was defeated, CMS is ready to authorize its contractors to begin paying physicians at the lower rate.
"Senate Fiddles as Medicare Burns"
The American Medical Association (AMA) warned that unless Congress restores the cuts, physicians will limit the number of Medicare patients they treat. A survey of 9000 members revealed that 17% of physicians — and 31% of those in primary care — would take such action because Medicare rates are too low.
Just before the vote, when the 6-month fix was still seen as viable, the AMA condemned it, saying that Congress has broken its promise to America's seniors and military families. In a news release titled, "Senate Fiddles as Medicare Burns," AMA President Cecil B. Wilson, MD, noted that Congress has been arguing about the "doc fix" for months.
"Delaying the problem is not a solution," Dr. Wilson said in the statement. "Continued short-term actions are creating severe instability that harms seniors as physicians make decisions to protect their practices from Medicare's volatility. Continuing down this path just slaps a Band-Aid on a problem that needs urgent surgery

 

[Garfield3d]

In yet another turn, which is quickly becoming formulaic, the Senate make a round-about face and decided to delay it again.

June 18, 2010 — In a surprise turnabout, coming the day after it had rejected the same measure, the US Senate reached a last-minute deal today to delay a planned 21.3% Medicare fee cut for 6 months. The legislation also provides a 2.2% payment increase.
Senate Majority Leader Harry Reid (D-NV) and Senate Minority Leader Mitch McConnell (R-KY) both said the compromise is "paid for" and will not affect the national deficit. Under Senate rules, the agreement was passed by "unanimous consent" without a roll call vote.
The legislators took turns complimenting each other on the new spirit of cooperation. They had used heated rhetoric to bash each other Thursday night after a $118 billion package for a 6-month delay in the Medicare pay cuts, plus a finance package that extends jobless benefits and provides $24 billion to states for their Medicaid programs, failed to pass.
The new pact was brokered by Senate Finance Committee Chairman Max Baucus (D-MT), who said the agreement was a "good omen" that the 2 parties could work together on the rest of the finance package in the future.
The last-minute agreement means that the pay cuts, which technically went into effect June 1, will be rescinded and physicians will be paid the full amount of their Medicare fees. If the Senate had not acted, the cuts would have gone into effect today.
Medicare contractors were ready to start processing June claims at the reduced rate, but the Center for Medicare and Medicaid Services was holding up the claims, anticipating that Congress would stop the reduction retroactively.
The House of Representatives must still pass the measure, and that is likely to happen Monday. The Center for Medicare and Medicaid Services acknowledges that the uncertainty about the fee cuts and delayed processing of Medicare claims may present cash-flow problems for some physicians, but it expects the delays to be only a few days.
Still Havoc for Practices
Medical groups are still upset that the "doc fix" is only for 6 months instead of providing a longer reprieve from threatened pay cuts.
"The reduction in payments, even if temporary, creates havoc for practices," the American College of Physicians said in a statement. "The situation is unacceptable and the frustration and anger is understandable." It said physicians need stable and predictable payments and called for a permanent fix.
Even before the vote Thursday, the American Medical Association (AMA) at its annual meeting in Chicago mocked Congress for failing to grapple with the pay issue, saying the "Senate fiddles as Medicare burns," and that a 6-month reprieve was inadequate. The AMA voted to formulate legislation for a new Medicare payment option that would allow patients and physicians to freely contract for payments that differ from the Medicare schedule, while allowing patients to use their Medicare benefits. "A new patient-centered category of Medicare payment will allow seniors to use their Medicare benefit fully for the healthcare they need," said David O. Barbe, MD, an AMA trustee.
Tensions were high in Washington, DC, after Thursday night's vote to reject the financial package, with each side sniping at the other. Democrats said Republicans were being obstructionist, and Republican legislators said Democrats were not serious about taming the national debt.
The Medicare pay cut issue is the result of a decade-old formula, called the sustainable growth rate, set up by Congress to slow the growth in Medicare spending. Reimbursement rates for Medicare would have been trimmed on a yearly basis, but Congress has deferred the cuts 9 times since 2003, almost always just days before planned cuts would take effect. Changing the formula was not included in the healthcare overhaul President Obama signed into law in March.
The AMA and other medical groups argue that any Medicare pay cut will harm patient access to care because physicians are less willing to treat Medicare patients. A survey of 9000 members revealed that 17% of physicians — and 31% of primary care physicians — would limit the number of Medicare patients they see because rates are too low.
After Thursday's vote, AMA President Cecil B. Wilson, MD, said, "Congress is playing Russian roulette with seniors' healthcare. Congress has finally taken its game of brinkmanship too far, as the steep 21% cut is now in effect, and physicians will be forced to make difficult practice changes to keep their practice doors open."
The pay cut drama of 2010 has taken a toll on medical practice finances, the AMA reports.
In response to the 2 short-lived rate reductions in March and April, 39% of physicians delayed payments for supplies, rent, or other expenses; 17% took out a loan or line of credit to pay bills; and 17% held up paychecks or even furloughed or laid off employees, according to the association's survey.
Such cutbacks make it less likely that medical practices will invest in health information technology and other improvements that policymakers consider vital to healthcare reform, the AMA notes.

http://www.medscape.com/viewarticle/723813?sssdmh=dm1.622598&src=nl_newsalert&uac=128648MT


--Garfield3d

 

[xiphoid2010]

Looks like they reversed the cut. Too late for the last billing cycle, but the reimbursement will be back up to previous level +2.2%.

http://money.cnn.com/2010/06/18/news/economy/medicare_congress/index.htm

What I want to know is "The bill was passed by unanimous consent after lawmakers found a way to pay for the boost without raising the budget deficit." How!? I'm guessing some new taxes hidden somewhere.

 

[xiphoid2010]

oops, double post

 

[Garfield3d]

What I want to know is "The bill was passed by unanimous consent after lawmakers found a way to pay for the boost without raising the budget deficit." How!? I'm guessing some new taxes hidden somewhere.

The operative term is "unanimous consent." Unanimous consent (also known as General Consent) is the quick type of voting where the chair says something along the lines of, "The issue is now up for vote, are there any objections?" to which if no one speaks up after a brief pause, then it is automatically passed under "unanimous consent." If someone does raise their voice under objection, then....

The vote goes to a "roll call" vote (which is probably what you're thinking of, and is also alluded to in the article). A roll call would require going down the line and polling each member one-by-one for their individual votes.

Chances are, in this second vote, it probably wouldn't have been unanimously approved in a roll call vote. However, the nays were probably hopelessly outnumbered, and so in the interest of time, they decided to not object so that unanimous consent could proceed.

As for how they became hopelessly outnumbered... I kinda wonder about how that happened too. Maybe the two sides had an agreement before the first vote, allowing the opposition to make a political statement while ultimately acquiescing in order to appear considerate to physicians and avoid damaging relations with their constituents? Or, maybe something was tacked on as pork-barreling?

In either case, I'm glad that it happened.

--Garfield3d