Friday, October 16, 2009

Medicare Physician Fairness Act of 2009

Senator Debbie Stabenow (D Mich) introduced the Medicare Physician Fairness Act of 2009 (S.1776) , which would eliminate the 21.5 % Medicare payment rate reduction for physician services in 2010 and sunset the application of the sustainable growth rate (SGR) formula.

This bill is going to move extremely quickly through the Senate. The Senate has scheduled a cloture vote on S.1776 for October 19, 2009 at 5:30 p.m., which will be preceded by one hour of debate. It will need the support of at least 60 senators on three procedural votes: a motion to end debate; a motion to waive a budget point of order because the measure is not offset in the budget; and a motion to proceed to the bill. Each of these will require a super majority of 60 votes. I expect they will have the votes for cloture.

There is great pressure from various special interests for the Senate to act on this before dealing with other health reform proposals. AARP and the American Medical Association (AMA) sent a letter to the Senate, urging Senators to pass S. 1776. The letter points to joint polling conducted by the AMA and AARP, which found that "two-thirds of people over 50 years old are either very or somewhat concerned that the current health care system limits their ability to see the doctor of their choice." AAMC President and CEO Darrell G. Kirch, M.D. also sent a letter of support for the legislation. The AAFP is using its Speak Out alert system to ask members to contact their legislators to support the bill. The Medical Group Management Association (MGMA) has partnered with the AMA to use its toll-free number to focus the collective grassroots efforts of both organizations.

There will be a full court press to get this passed quickly. It will fix some serious problems - if the Medicare cuts are not stopped then budget rules would require the accumulated SGR debt to be taken from other services or additional revenue measures would be required. Resetting the debt amount would provide Congress with additional flexibility to come up with a workable physician fee schedule that is based more on patient safety and quality of care.

However, the bill would cost about $245 billion, and this could create even more pressure to keep costs down on other reform efforts. And or fiscally moderate Senate Democrats, the defecit spending will be hard to swallow. Senate Budget Committee Chairman Kent Conrad, D-N.D., and Senator Evan Bayh, D-IN, both said they would vote against the measure. Senator Bayh said it should "absolutely be paid for."

"Look, one of the things we're trying to do is reform health care in a way that's fiscally responsible and doesn't drive up the deficit. A vote that will increase the deficit by $245 billion violates that principle," he said.

Ultimately, I think the bill will pass. Unfortunately it will also make it more difficult to reform the rest of the healthcare system.