Physicians would get Medicare fee increases for the next two years but may have to switch to electronic prescriptions by as early as 2006 in the House version of the Medicare prescription drug bill, lobbyists for physicians and practices say.
These changes could all be finalized and signed into law in a matter of weeks, they add, because President Bush is asking Congress to pass a prescription-drug benefit by its July 4 recess.
Physicians interests are cheering the House version's proposed fee fix, which would replace an expected 4.2% cut in physician pay for 2004 and an unknown cut for 2005 with increases of at least 1.5% for both years.
But lobbyists say the House bill's deadline for e-prescribing standards, which they understood to be 2006, would come too soon.
"Switching over to electronic prescribing is a good thing, but to expect physicians to do so in a little over three years is just not realistic," says Robert Doherty, senior vice president for governmental affairs and public policy at the Philadelphia-based American College of Physicians.
"The vast majority of physicians are not prepared to do electronic prescribing now," he says.
According to the text of the Medicare bill, HHS would create standards for e-precribing by 2006, but the bill does not mention when the standards would go into effect.
By the end of the week, the House Ways and Means Committee and the Energy and Commerce committees will have finalized their versions of the bill, and any differences would then be ironed out in conference before the bill goes to the House floor, says Paul Speidell, a lobbyist in MGMA's Washington office.
The Senate version of the Medicare prescription drug bill, a bipartisan document passed by the Senate Finance Committee last Thursday, does not contain the fee fix or e-prescribing deadline. But the Senate bill does contain a last-minute amendment to restrict physician investment in specialty hospitals, which is worrying lobbyists for specialty hospitals.
The new provision would amend the Stark law, which bars doctors from referring Medicare patients to health facilities in which they have an ownership stake. Specifically, it would narrow an exception in the Stark law for physicians who have a stake in a "whole hospital," and not just a hospital department.
The exclusion would no longer be applied to "those circumstances in which a physician's ownership interest is in a hospital that primarily or exclusively is devoted to cardiac, orthopedic, surgical, or other specialties designated by HHS regulation as inconsistent with the original intent of the law," the finance committee states.
Meanwhile, physicians' groups are more interested in the provisions in the House bill.
In a in a letter on the House bill to Ways and Means Chairman Bill Thomas (R-Calif.), dated Monday, the ACP praises the fee fix but voices concerns about the e-prescribing deadline and a provision that would go beyond the fee fix and change the formula to calculate physicians fees.
To avoid dramatic changes in physician fees, the bill would require that the sustainable growth rate, which is used to calculate fees, be based on a 10-year rolling average of changes in per-capita gross domestic product.
Although the ACP, the AMA and other physicians' organizations have been urging a change in the formula, Doherty says the change does not go far enough. He says the government should remove the GDP from the formula and mitigate the impact of Medicare coverage for new drugs and procedures on the formula.
But Doherty adds that Congress will have time to consider more changes in the formula if the two-year fee fix is passed.
"That (fee fix) gives us two years' respite," he says. "During that period of time, we're going to have to work with the House and Senate to make revisions of the formula."