President Bush's chief health policy adviser says Congress and the White House could stabilize Medicare physician payments, but he adds that enhancing benefits will remain as the Bush administration's priority.
Mark McClellan M.D., serves on the President's Council of Economic Advisers, is his point person in drug benefit relations with Congress and tops his list of candidates to head the Food and Drug Administration.
McClellan met consistently with senators in September to try and find agreement on the very political prescription drug benefit that has bogged down other legislative efforts to reform Medicare. And his message to attendees of a September Medicare/ Medicaid conference hosted by the American Association of Health Plans is that provider payments will get done, despite the Senate's failure in July to pass a Medicare prescription bill.
"But our first priority is improving Medicare benefits," he says. "That means strengthening Medicare+Choice and prescription drug coverage."
Meanwhile, the AMA reports that 24% of physicians have limited or plan to limit the number of Medicare patients they treat because of reduced reimbursement.
"The (payment) train is moving swiftly and steadily to the station," says Colin Roskey, minority staff for the Senate Finance Committee, where details of a $35 billion provider give-back plan were being discussed (see box). The House passed a bill with $30 billion in payment fixes, and Roskey says the two sides are reconcilable.
At deadline, what final vehicle Senate relief would take-whether as a stand-alone bill, part of a continuing resolution or an appropriations amendment-remained undetermined.
"I'm not going to sit by and give back $35 billion to providers without giving one nickel for pharmaceuticals to seniors," says Sen. John Breaux (D-La.). "I'm going to do it and they're going to have to vote on it."
McClellan holds on to hope for bipartisan action, referring to passage of a trade bill in July with health insurance tax credits for laid-off workers.
"People thought healthcare issues there would be intractable as well," he says. He emphasizes Bush's proposal for a one-time minimum payment increase of 6.5% to Medicare. He also supports the administration's push for competitive bidding among Medicare+Choice plans.
AAHP president Karen Ignani in September announced that 200,000 seniors will lose access to Medicare+Choice next year as more plans pull out of the program due to inadequate reimbursement.
Antitrust scrutiny complaint
So far this year, the Federal Trade Commission has announced five antitrust settlements with physician groups, which drew a complaint from the AMA president-elect, Donald Palmisano, M.D.
"Federal antitrust agencies have placed physicians under a far higher level of scrutiny than is warranted by our comparative strength in today's healthcare system," Palmisano said at an FTC healthcare antitrust and competition workshop. "By comparison, we know of no FTC action against a third-party payer, ever."
Deputy Assistant Attorney General Deborah Majoras says regulators are looking more closely at insurers. She says officials were investigating claims by providers against payers that all-products and most-favored-nation clauses were anti-competitive and provided disincentives to physicians to lower rates.
What physicians want (and may yet get) from the Senate
- A 2003 payment update of 3% to cover documented increases in practice costs and to offset the 5.4% cuts received in January.
- Legislation that would provide for higher 2004 and 2005 payment updates, reflecting recently revised CMS estimates of medical practice cost inflation for 2003 (up from 1.6% to 3%).
- Attention to longer-term structural reforms in the update system needed after 2005, such as eliminating the possibility of future cuts.