The House Ways and Means Committee yesterday approved a Medicare prescription drug and reform bill that includes two amendments to increase physician reimbursement for delivery of drugs related to specialties and for doctors in primary care or specialty shortage areas.
In a near-party-line vote of 25-15, the committee agreed to pass the Republican-sponsored bill, HR 2473, despite bitter arguments from Democrats that it is an attempt to privatize Medicare. The Energy and Commerce Committee continues its markup of the bill and is expected to vote on it by the end of the week.
Rep. Nancy Johnson (R-Conn.) offered an amendment to address the problem of underpayment in the physician fee schedule for delivery of certain drugs in specialties such as oncology. Her amendment would direct the secretary of HHS to speed the process for adjusting existing CPT codes for costs associated with the administration of covered outpatient drugs to assure that those Medicare services are adequately reimbursed.
An amendment from Reps. Jim Nussle (R-Iowa) and Earl Pomeroy (D-N.D.) would pay physicians a new 5% Medicare bonus in counties identified as primary care or specialty scarcity counties, or both. Scarcity counties would include the 20% of Medicare beneficiaries who have the fewest primary care or specialty physicians per beneficiary
"Our understanding of those amendments is that both would help improve reimbursement for physicians, and so we're happy with that," says Paul Speidell, government affairs representative for the Englewood, Colo.-based Medical Group Management Association.
He says MGMA members are "very, very excited" that a 1.5% minimum physician payment increase for 2004 and 2005 remained in the bill after the Ways and Means debate, and he says he is hopeful it will be included as currently written in the Energy and Commerce markup. That provision would stave off a 4.2% expected cut in physician pay for 2004.
"We're basically in favor of anything that helps improve physician payment as long as it doesn't move from anywhere else in the physician payment pot," Speidell says. "We wouldn't want to rob Peter to pay Paul."
AMA President Yank Coble, Jr., M.D., says in a written statement, "The physician payment provision averts a Medicare meltdown by reversing the cuts predicted for 2004 and 2005 due to the flawed Medicare payment formula. The current formula is tied to the ups and downs of the economy."
Regarding the prescription drug benefit, Rep. Pete Stark (D-Calif.) calls the bill a "rotten deal for seniors" because, he says, there is nothing in the measure that requires anyone to provide drug coverage.
But Ways and Means Chairman Bill Thomas (R-Calif.) says that is true for all Medicare providers and hence reinforces the fact that the prescription drug provision is "absolutely part of Medicare."
"There is no guarantee that (plans) will remain, just as there is no guarantee that a physician will participate from year to year," Thomas says.