AOPA
in AdvanceBreaking News for O&P Professionals
December 6, 2007: SPECIAL EDITION
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ADMINISTRATION AND CONGRESS
SQUARE-OFF ABOUT MEDICARE BILL
Congress’ efforts to pass a Medicare bill before the end of the 2007 Congressional session seem to be falling on pretty hard times and the bill may not even materialize, at the earliest, until next year.
Congress’ efforts to pass a Medicare bill before the end of the 2007 Congressional session seem to be falling on pretty hard times and the bill may not even materialize, at the earliest, until next year.
The need
for a Medicare bill is urgent: if Congress does not intervene, the
statutory
formula will mandate that as of Jan. 1, 2008, the Medicare payments for
each and
every Medicare service to every physician in the country will be cut by
10%.
Passing a bill that will short-circuit this planned Medicare cutback
(known as
the “doc fix”), and how to pay for it, is driving
the controversy around this bill.
The House,
this summer, passed its version, which would eliminate the January 1
Medicare
reductions, and would have paid for these through a combination of
increased tobacco
taxes and reductions in payments for a managed care program called
Medicare
Advantage.
The Senate
Finance Committee has not yet prepared a bill for a vote in the Senate,
but appeared
to be close to having a bill and scheduling a committee session wherein
the
bill would be refined and “reported out” of the
Finance Committee. Once it
leaves committee the bill could be voted on by the full
Senate.
The date when
the Finance Committee will meet keeps being postponed. This had been a
result
of the Senators not agreeing with the way the House would
“pay for” the “doc
fix” bill. Now the Department of Health and Human Services
has made some
recommendations about the content of the bill and this further
complicates the
issue.
This latest
dispute between the Executive Branch and the Senate Finance Committee
is a
consequence of HHS Secretary Leavitt’s recent letter to
Finance
Committee Chairman Sen. Max Baucus (D-MT) and Ranking
Minority
Committee Member Sen. Charles Grassley (R-IA). The letter
indicated
what the Administration considers as permissible in the
Medicare bill, and
what would prompt a Presidential veto of the
bill. Specifically, Leavitt’s
letter threatens that the bill will be vetoed if it pays for the
“doc fix” by
cuts to the Medicare Advantage program. Additionally, Secretary Leavitt
explains that the Administration will accept a bill if it
“pay[s] for any
adjustment to the physician fee schedule formula by responsibly
adjusting
payments to other providers in the fee-for-service Medicare
program.”
This is NOT
good news for O&P—those adjusted payments (cuts)
would affect hospitals,
nursing homes, DME and, potentially, the O&P field. In fact,
the House bill
has involved modest cuts to hospitals, nursing homes and DME, but in
that bill
there have been no proposals for cuts to O&P. The
Leavitt letter,
however, could set the stage for some across-the-board percentage cuts
to all
non-physician providers to avoid cuts to physician fees.
Showing
some early resistance to the Leavitt letter, Sen. Grassley (R-IA)
responded to
the President’s veto threat by saying that “Senator
Charles Grassley doesn’t want
to be responsible for doctors getting a 10 percent cut… if
the president wants
to be responsible for it, let him be responsible for it.”
Also, at this moment,
the Democrats leading the House and Senate don’t seem to want
to finance the
“doc fix” on the backs of other providers. But we
are still at a stage where
anything can happen.
On the
positive side, AOPA, working with the O&P Alliance, has been
pushing hard
for some provisions in this bill that would help tighten up on fraud
and abuse,
and begin to link payment, complexity of patient needs, and
qualifications of
provider.
To conclude, this disagreement indicates that following
things are still
unclear:
-
Whether there will be a bill this year
-
Whether the proposed new O&P provisions that we have been promoting will be included in that bill
-
If there is a bill, whether it can still be paid for in a way that does not involve cuts in fees for O&P and other Medicare providers
- And if there is a bill, will it be vetoed by the President
It seems
there may be an effort by the Senate to take the unusual step of
negotiating a
final bill directly in a conference with the House and then bringing
that conference
bill to the Senate for a final vote. There is also the prospect that
nothing
will be done on Medicare until 2008. Rep. Pete Stark (D-CA), primary
author of
the House Medicare bill, offered a novel response to the
Administration’s veto
threats: suggesting that Congress attach the Medicare reforms to an
end-of-the-year omnibus spending bill or legislation funding the war in
Iraq. In either of those cases, the
President may be hesitant to veto Medicare changes that he dislikes at
the
expense of those larger priorities.
Regardless,
AOPA is working hard, following each turn in this drama, representing
your
interests, and we will continue to keep you informed.
Questions? Contact Steven Rybicki at (571) 431-0835 or srybicki@AOPAnet.org.
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