In their uphill struggle for relief from the ongoing Medicare-reimbursement cut of 17% through 2005, physicians may have to compete for funds with a proposed Medicare drug benefit, a call to fix Medicare+Choice and hospitals' push to maintain their own reimbursement levels.
Legislation from the House Republican leadership, expected to be introduced this month, would roll all proposed Medicare changes into one package and let each interest group contend for its share, lobbyists for physician groups say.
The biggest rival for funds would be the AARP's proposed drug benefit, worth $750 billion over 10 years. The AARP wants it funded before it will discuss any relief for physicians, putting physician groups in an awkward position, says Anders Gilberg, a lobbyist for the Medical Group Management Association.
"We probably all support a reasonable drug benefit," he says, but "our basic position is that the physician payment issue needs to be addressed independently of any drug benefit."
The anticipated bill also could conform to the Bush administration's call for budget neutrality for Medicare provider pay-so any increases for physicians mean cuts for hospitals, Gilberg and other physician lobbyists say.
They think the new bill could clear the House as early as Memorial Day, then go to the Senate for a vote targeted for September.
Making things worse, physicians also must contend with a federal budget depleted by tax cuts and post-Sept. 11 national security spending. "Now that we're in the budget deficit cycle, it's going to be much more difficult," concedes Warren Jones, M.D., president of the American Academy of Family Physicians, who has been visiting Congress and the Centers for Medicare and Medicaid Services to plead for relief.
To restore the cuts, physicians want to end Medicare's sustainable growth rate payment formula, or at least change the way it is calculated. Tied to the gross domestic product, it pulled down physician pay when the economy stalled.
"There is no rational connection between the healthcare needs of the elderly and the nation's economic performance as reflected in the GDP," Jones told the House's small business committee April 10.
Physician lobbyists still have to convince Congress eliminating the formula won't cost too much. The change's official price tag had been $126 billion over 10 years, but on April 17 CMS reduced the estimate to $106.7 billion after congressional prodding. Physician groups insist the figure is less than $50 billion.
Meanwhile, according to physician lobbyists who requested anonymity, hopes are dimming for the repeal of a 5.4% cut imposed Jan. 1, even though a 2001 bill dealing with the issue remains active.