Many leaders in organized medicine are hailing passage in the Senate this morning of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
American College of Physicians president-elect Charles Francis, M.D., says the bill meets all of ACP's major policy objectives. "It represents a huge step forward for the healthcare of America," he says.
The 54-44 Senate vote followed the defeat on Monday of two Democratic attempts to delay action on the bill. A filibuster led by Sen. Edward Kennedy (D-Mass.) was blocked 70-29, and a budgetary point of order that would have killed the bill, lodged by Senate Minority Leader Thomas Daschle (D-S.D.), was halted 61-29. The House on Nov. 22 narrowly passed the measure 220-215.
The bill now heads to President Bush, who has said he is eager to sign the historic $400 billion, 10-year measure, which will add a prescription drug benefit, forge a bigger role for private health plans and create new tax-advantaged healthcare savings accounts.
A flurry of written statements from medical associations support the legislation, although some acknowledge there are troublesome provisions for certain doctors, such as cuts in reimbursements for drug acquisition costs by oncologists and an 18-month moratorium on physician self-referral to specialty hospitals.
"This truly significant legislation also enhances access to care for seniors by halting Medicare cuts to physicians and other health professionals for the next two years," says AMA President Donald Palmisano, M.D. "Instead of cuts, the Medicare bill provides at least a 1.5% increase in payments in 2004 and 2005. For next year, this represents a 6% difference in Medicare payments at a time when physician practice costs are on the rise."
William Jessee, M.D., president and CEO of the Medical Group Management Association, says, "Although this bill is not perfect, halting the cut in Medicare reimbursement is a critical step in the right direction."
He says Congress and the medical community now have time to develop long-term improvements to the flawed Medicare physician reimbursement formula. "The first order of business when Congress returns in January must be redesigning the physician payment formula to accurately and adequately reflect the true cost of providing quality care and continued access for Medicare beneficiaries."
The recommendation that reimbursements for all physicians, whether they work in rural or urban areas, begin from the same floor is important to family medicine, says Michael Fleming, M.D., president of the American Academy of Family Physicians.
Fleming also praises the bill's one-year moratorium on CMS practices governing the payment of graduate medical education (GME) funds to hospitals that prohibit the use of volunteer teachers in nonhospital settings.
In an online memo to members of the American Society of Clinical Oncology, ASCO president Margaret Tempero, M.D., laments the retention of a large portion of cuts to cancer care via drug payment reductions. Medicare payments for drugs administered in physicians' offices, which are currently 95% of average wholesale price (AWP), would be AWP minus 15% in 2004, average sales price (ASP) plus 6% in 2005, with competitive bidding as an option for physicians in 2006.
The bill provides a transitional increase of practice expense reimbursements that the Congressional Budget Office estimates will increase total payments to oncologists and hematologists for drug administration services from about $300 million currently to about $600 million in 2004. But ASCO contends those increases are not enough to offset the drug payment cuts.
"We are working to determine if there are technical amendments that could improve or clarify the final legislation," Tempero says. "If so, we will work with our allies in Congress to introduce these in the next year."