Lobbyists for both physicians and hospitals are satisfied--at least for now-with the Medicare reimbursement fixes in a proposed House bill.
Changes embodied in the legislation would increase payments to hospitals by $9.2 billion over 10 years, part of a deal struck with House Ways and Means Committee Chairman William Thomas (R-Calif.). Previous drafts had called for a cut of $17 billion.
The agreement also would temper decreases to medical schools and raise the reimbursement rates for rural and suburban hospitals to equal the rates received by urban facilities.
Physicians, for their part, would get relief from the 5.7% cut planned for 2003, with a 2% increase each year through 2005.
The hospital gain likely will be balanced by decreasing the $350 billion, 10-year House GOP prescription drug benefit.
"Ways and Means has hospital organizations and many physician organizations on board, which gives them the green light, more or less, to move this," says Anders Gilberg, government affairs representative for the Medical Group Management Association.
The GOP plan, originally due to move by Memorial Day, had been stalled by disagreement about provider payments and internal arguments over more structural reform of Medicare. A new goal is passage before lawmakers' Fourth of July recess.
But the House Republican prescription benefit is expected to meet with dissent in the Senate, where Democrats in June unveiled their own, more expensive drug plan for seniors, which would cost $425 billion over eight years. "The Senate may do something separate for providers," Gilberg says. "Our large-scale grassroots efforts will shift there after the bill passes the House."
Meanwhile, the Patient Safety and Quality Improvement Act, introduced in early June, would create new patient safety organizations (PSOs). Physicians and other providers could voluntarily report certain medical mistakes in confidence and without fear of legal retaliation, and the PSOs would study the data and give feedback to prevent future errors.
Doctors and hospitals are pleased with the bill--introduced by Sens. John Breaux (D-La.), Bill Frist, M.D. (R-Tenn.), Judd Gregg (R-N.H.) and James Jeffords (I-Vt.)--and a parallel House measure sponsored by Rep. Nancy Johnson (R-Conn.).
"We need to transform from a culture of shame and blame to one of candor and analyzing the systems that produce errors," says Donald Palmisano, M.D., secretary-treasurer of the AMA.
At issue in understaffed EDs is the lack of guidance for structuring on-call schedules in the first revisions by CMS to the 1986 Emergency Medical Treatment and Labor Act.
The proposed rule changes allow hospitals to determine their own on-call schedules. But doctors are concerned that no instruction was provided about how often they must be on call, or if they would get paid for it.
"We'd like to have clear guidance that encourages regional on-call coordination under a local EMS plan," says Loren Johnson, M.D., president of the California chapter of the American College of Emergency Physicians and ED medical director at Sutter Davis Hospital in Davis, Calif.
HHS will accept comments on the proposed rule changes through July 8. Final rules are expected to be issued Oct. 1.