Physicians eager to prevent a Medicare pay cut next year came close to the finish line when the House of Representatives passed a bill that would have allowed the Bush administration to fix the formula that sets their payment rates. The Senate scrapped the race, however, when it rejected the measure, which was included in a bill to create tax equity for military personnel.
The defeated measure would have given the Centers for Medicare and Medicaid Services the authority to adjust the Medicare physician payment formula to increase physician payments in upcoming years. CMS Administrator Thomas Scully has said he would repair the formula if given the authority to do so.
The CMS declined to comment on last week's developments.
Although the Senate passed the military spending bill, it opted not to include the physician payment measure, ending the American Medical Association's effort to see the formula repaired by year-end.
After the Senate vote, an AMA spokeswoman said only that "the Senate is still in session," referring additional inquiries to a written statement.
"Senate inaction on (physician payment) puts Medicare patients in dire jeopardy," the statement said. "Everyone agrees this mistake should never have occurred. It should have been corrected months ago."
Physicians took a 5.4% Medicare pay cut this year under what is widely considered a flawed payment formula. Unless the formula is recalibrated, physicians' Medicare reimbursement will decline 12% during the next three years as their practice expenses rise 40%, according to the AMA.
If the Senate hadn't squashed the House measure allowing Scully to fix the formula, lobbyists said, the physician payment rate could have increased by as much as 1.6% next year, instead of declining by 4.4%.
After it passed bills to create the federal Department of Homeland Security and to fund terrorism insurance coverage, the House adjourned, having not included any provider payment relief in a continuing budget resolution that will fund government programs through Jan. 11.
"We're disappointed they failed to act before they left," said Thomas Nickels, senior vice president of federal relations at the American Hospital Association. "We've been working all year with other provider groups to get relief. Now we're hoping (Congress) will regroup and do it as soon as possible next year."
Few lobbyists and Capitol Hill staffers said they expected Congress to take action on a sweeping $43 billion provider relief bill during its lame duck session that started last week. Introduced in September by Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.), that bill will face the scrutiny of a Republican-controlled Senate next year.
To see passage, it will need to be reconciled with a House-passed prescription drug bill that contained similar relief provisions.
When Congress convenes again in January, lobbyists hope they can count on hospital advocates such as Grassley to move provider relief forward. In the next session, "Republicans can really rule the roost on budget issues," said Chip Kahn, president of the Federation of American Hospitals in Washington. The Republicans, he said "will get a lot of our attention."