House leaders said they would take up a healthcare-heavy bill that temporarily patches Medicare physician payments early this week, though it could prove a tough sell to increasingly cost-conscious lawmakers and to providers divided over some of the provisions.
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SGR fix on tap, but AMA 'disappointed' by measure
While the bill tackles a wide spectrum of tax extenders, loopholes and a variety of other programs, Medicare and Medicaid changes dominate throughout, accounting for the lion's share of its 10-year, $170 billion price.
Under the package, physicians would see a 3½-year “fix” to the troublesome Medicare physician payment formula, which comes with a preliminary estimate from the Congressional Budget Office pegged at $64.9 billion.
The bill would temporarily revise reimbursement calculations so that doctors could get a 1.3% update through the balance of the year, with a 1% update promised for 2011.
From 2012 through 2013, however, the pay formula gets tweaked. Pay increases would be measured if physicians meet certain cost-containment targets. But Medicare would return to its original sustainable growth-rate formula in 2014, setting physicians up for a possible 32% cut in that year.
The bill also includes measures that: extend a federal increase in Medicaid funding for six months; extend the COBRA premium subsidy to employees laid off through the end of the year; extend the 340B drug coverage program to include inpatient drugs for the uninsured; and extend Medicare Section 508 wage reclassifications through 2011.
Physician group reaction was mixed. In a written statement, American Medical Association President J. James Rohack said they were “deeply disappointed that Congress will once again fail to permanently correct the Medicare physician payment formula.”
“The pending Medicare proposal treats the symptoms—it's not a cure for the disease,” Rohack said.
Other physician groups were more supportive of the measure, breaking from the AMA. The American Osteopathic Association, in a letter sent to congressional leaders, said it is “pleased” with the provisions that will allow the formula to determine the size of future payments vs. having cuts set out in law.
Physicians aside, the hospital lobby, which is largely supportive of the bill, said it would fight against a measure that could restrict services under the so-called “72-hour rule.” That provision could expand the list of services that are not eligible for reimbursement under the Medicare rule, which essentially bars the unbundling of payments for therapeutic services unrelated to a hospital admission if they are performed within 72 hours of an admission.
The American Hospital Association said it could cost the nation's hospitals about $4.5 billion if implemented. Recovery Audit Contractors have found that hospitals have been bundling services that should have been billed separately, according to the AHA.
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