Weeks after the terrorist strikes on New York City and Washington, Congress continues to focus on national security to the exclusion of healthcare and other matters.
Lawmakers have shelved key healthcare issues such as patients' rights and Medicare reform, causing physicians to pursue items, including Medicare physician payment increases and regulatory reform, that are presumably less controversial and easier to push through.
National security, however, does involve physicians to some extent. The General Accounting Office reported in September that the U.S. suffers from "inadequacies in the public health infrastructure," including a lack of planning for emergencies, incapacity in terms of responding to an emergency and lack of timely availability of medical teams.
As a result, Congress and the White House are calling for more spending on public health. For example, Sens. Ted Kennedy (D-Mass.) and Bill Frist, M.D., (R-Tenn.) urged President Bush in a Sept. 21 letter to "commit sufficient resources to developing medical counter-measures against a bioterrorist attack," including ensuring that "health professionals are adequately trained to respond to bioterrorism."
The senators called for a $1.4 billion funding increase over the current $400 million HHS is spending to improve the nation's preparedness for bioterrorism.
The total includes $635 million for upgrading state and local bioterrorism epidemic monitoring, as well as assuring adequate staffing and training of health professionals. At this point, the actual level of spending is still being decided by legislators and the White House, says Kennedy spokesperson Jim Manley.
Doctors, for their part, are already taking steps, says Tim Flaherty, M.D., chairman of the board of trustees of the AMA. The AMA has put up a number of articles on bioterrorism on its Web site, he says, and there will be special breakout sessions on the subject at the organization's interim meeting in December.
"We want physicians to have a reliable source to refer to," says Flaherty, a radiologist from Neenah, Wis.
Meanwhile, doctors are working on other issues, such as reimbursement from Medicare. For years, physicians have complained that the compensation methodology that the Centers for Medicare and Medicaid Services (CMS) uses--the sustained growth rate--is flawed. A key reason for this is that it uses GDP rather than a metric more closely related to medical inflation, Flaherty says.
In 1999, Congress gave CMS the authority to adjust the formula, but CMS has asked doctors to go to Congress and ask that it be permanently altered, he says.
"Our concern right now is that CMS has decided to put physician reimbursement into the legislative arena," Flaherty says.
Meanwhile, Congress is preoccupied with fighting terrorism and might not get around to changing the formula. Without a change, doctors "have the potential of a significant decrease" in reimbursement beginning Jan. 1, Flaherty says.
Although the final figure hasn't been released, Flaherty estimates it could be a decrease of 1% to 7% from 2001. Since 1991, doctors have received annual average increases of 1.7%.
On another front, the House Ways and Means Committee on Oct. 11 approved a bill to streamline Medicare. The Medicare Regulatory and Contracting Reform Act of 2001 would reduce paperwork for doctors and release new or updated regulations only once a month. It also would give doctors new protections when facing audits.
The bill is a "solid first step in providing regulatory relief for overburdened physicians," says Randolph Smoak, immediate past president.
The bill must be reconciled with similar legislation, which on Oct. 17 passed the House Energy and Commerce Committee's subcommittee on health, before it can go to the House floor. That process is sure to be delayed due to anthrax incidents on Capitol Hill and the subsequent shuttering of the House until Oct. 24.
Doctors needn't be too concerned about making gains in Medicare reimbursement or regulatory relief, given bullish trends in the private sector.
Employer-paid health insurance premiums are likely to rise in excess of 14% in 2002, says Brad Kimler, a principal with Hewitt Associates in Boston. That's about the same increase employers saw this year, he says. While prescription drugs account for a good part of the rise, Kimler also attributes it to more leverage by providers, including doctors. He says he sees more aggressive bargaining by doctors and hospitals than was the case a few years ago.
Right now, plans need the physicians and hospitals more than the other way around, Kimler says. As a result, he says, doctors and hospitals should be getting healthy increases in reimbursement in 2002.