Senate and House negotiators agreed to replace a 4.4% cut in Medicare physician fees with a 1.6% increase, but the measure is part of a omnibus spending package that has not been approved yet, lobbyists for physician groups report.
Congress has until Thursday evening to agree on the omnibus bill and pass it in both houses, because on Friday the lawmakers start a weeklong recess and won't be back in time to avert the planned 4.4% physician fee cut scheduled for March 1, lobbyists say.
Last week, HHS Secretary Tommy Thompson warned that CMS needs about a two-week lead-time to implement any fee changes for March 1.
"This is not a done deal until the (House-Senate) conference negotiations are fully agreed upon, then this goes back to the House and the Senate for final approval and is signed by the president," says Rich Trachtman, a lobbyist for the American College of Physicians-American Society of Internal Medicine.
He adds that the only potential sticking point appears to be the conference negotiations. If negotiations break down, Congress would have to pass what would be its ninth continuing resolution for this year's budget, because the eighth continuing resolution expires a week from Thursday, he says. If that happens and the 4.4% fee cuts go into effect, Trachtman says it would be messy for Congress to undo the cuts later.
"It's important that at all costs we avoid that (scenario)," he says.
The fee increase the negotiators passed would amount to $1.5 billion to $2 billion more in physician revenues for the rest of the year than was expected under the fee cut, Trachtman says.
He says the compromise more closely resembles what the House passed in November than the less generous provision that the Senate passed on Jan. 23.
The Senate provision called for a seven-month fee freeze--without any fee increase--and would require further action before that period expired. But the compromise version would, in addition to the 1.6% increase, allow for further unspecified changes in coming years when further cuts are scheduled, Trachtman says.
He says the increases would be made possible by allowing CMS to correct two mistakes in current calculations of the fee schedule, which CMS says need congressional approval. The two mistakes are an underestimation of the gross domestic product and an overestimation of the number of Medicare beneficiaries who would enter Medicare HMOs.
But Trachtman adds that the fix does not address the fee formula, which physicians groups say is also in error.