The Senate is expected to pass a bill late Tuesday night repealing and replacing Medicare's sustainable growth-rate formula for paying physicians.
If it passes without amendments as expected, President Barack Obama has indicated he will sign it. If amendments are added, that would introduce delays because the bill would have to be reconciled with the House version.
Passage of the bill Tuesday would stave off a 21.2% cut in payments to doctors one day before the CMS is set to begin processing claims at the reduced rate. The legislation would end a cycle of 17 consecutive short-term fixes that have spanned more than a decade.
“It's important that we stop kicking the can down the road,” Sen. John Cornyn (R-Texas), the Senate majority whip, said during a speech Tuesday on the Senate floor.
The House passed the physician-payment reform package last month by an overwhelming majority in a rare show of bipartisanship. The deal was cooked up behind closed doors by House Speaker John Boehner and Minority Leader Nancy Pelosi.
The legislation would establish a new two-track payment system for doctors that's designed to prod them to move more of their patients into risk-based payment models. The legislation also extends the Children's Health Insurance Program by two years and allocates $7.2 billion in additional funding for community health centers.
Only about one-third of the $200 billion-plus package is offset by corresponding spending reductions. Those cuts are split about evenly between reduced payments to healthcare providers and increased costs for beneficiaries. The failure to pay for the entire package has angered some conservative Republicans.
“Do you want to know how a country goes broke?” Sen. Jeff Sessions (R-Ala.), a leading critic of the bill, asked Tuesday during a floor speech. “It's managing money this way.”
Democrats were upset that CHIP wasn't reauthorized for four years and by the increased costs for Medicare beneficiaries. But most were expected to swallow those concerns and back the bill. The CMS actuary said last week that the new payment system may well lead to inadequate doctor payment rates after 2049, which might require future Congresses to again face the need for doc fixes.
A half dozen amendments were teed up for Senate floor debate to allow senators on both sides of the aisle to express their misgivings. One such amendment, introduced by Sen. Mike Lee (R-Utah), would require that the entire package be paid for by corresponding spending cuts. Another amendment, offered by Democrats, would provide for a four-year CHIP re-authorization.
But if any of those amendments pass, it would require that the legislation return to the House for another vote. The hope was to avoid such a scenario given the broad, bipartisan support in the House. It's expected that the amendments will fail.
The American Medical Association sent a letter to Senate leaders Tuesday urging passage of the bill without adopting any changes. "The failure of the Congress to complete work on this bill today will create serious disruptions for physician practices, patients and Medicare contractors," wrote Dr. James Madara, the group's CEO.
Boehner warned against making any changes to the bill. “The House legislation passed with overwhelming bipartisan support, and we do not plan to act again,” he said in a written statement. “So we urge the Senate to approve the House-passed bill without delay.”
