SGR Deadline Nears (Medicare doctors' pay cut scheduled for March 1, 2010)

Med Page Today ^ | February 19, 2010 | Emily P. Walker

[hocndoc]

When Congress returns from the Presidents Day recess next week, lawmakers will have just seven days to pass a bill to prevent a 21% cut in Medicare reimbursement.

Racing the clock to prevent cuts dictated by the sustainable growth rate (SGR) is nothing new. Every year over most of the past decade, Congress has voted at the eleventh hour to push planned cuts off for a year.

"Congress has a clearly established pattern to wait until the last minute to do a temporary patch," Cecil Wilson, MD, an internist in Winter Park, Fla., and president-elect of the American Medical Association (AMA) told MedPage Today.

Bob Doherty, executive vice president of governmental affairs for the American College of Physicians (ACP), said it's unlikely doctors would actually be subjected to the planned cut come March 1. What's not clear, he said, is what form the legislation will take -- if it will be a standalone bill or rolled into another bill being considered by Congress next week.

"'We don't know' is the honest answer," Doherty said during a Wednesday press conference unveiling a report addressing the "declining state of American healthcare" and the need for healthcare reform.

"What we are hearing is that one way or the other, somehow, something will stop the cuts from being enacted," he said.

Two high-ranking senators -- Max Baucus of Montana, and Charles Grassley of Iowa -- were set last week to include a seven-month reprieve from the cuts in a jobs bill, but Senate Majority Leader Harry Reid instead introduced a scaled-down bill that did not contain the SGR temporary fix.

"We will work to get a bipartisan agreement as soon as possible," Regan Lachapelle, a spokesperson for Sen. Reid, told MedPage Today.

While physician groups are expecting Congress to come up with some short-term fix next week, they are growing increasingly tired of the temporary patches and are pushing hard for a permanent repeal to the way physicians are reimbursed under Medicare.

"I hope we can stop this game of legislative chicken," said Wilson. "Seniors and physicians need to put pressure on their senators to support a comprehensive fix."

"We cannot support another temporary patch," said Joseph Stubbs, MD, an internist in Albany, Ga., and president of the ACP.

The House has passed a permanent repeal to the SGR, but the Senate has not.

While the ACP is intensely focused on the SGR issue this week and next, the group is not taking a break in its push for the passage of healthcare reform, said Doherty.

However, "the year-long reform effort remains stalled with no clear path forward," he said. Healthcare legislation stalled following the recent election of Massachusetts Republican Scott Brown to Ted Kennedy's old Senate seat.

Some lawmakers now seem to favor abandoning the sweeping healthcare bills passed by the House and the Senate in favor of smaller, narrower bills, coming up with a new broad bill, or using a legislative tool called reconciliation, which doesn't require 60 votes to meld the current bills.

Doherty wrote off these alternatives. Smaller bills will fail to have a large impact on the healthcare system, and the opposing party in Congress always wants to start over, he said.

As for passing a bill through reconciliation -- the procedure is reserved for budget bills, so any portion of the healthcare reform bill that does not reduce or raise revenue or relate to an entitlement program would stripped out. That would likely include insurance purchasing pools and the health insurance exchange, said Doherty.

The president is hosting a bipartisan meeting on Feb. 25, and Doherty and Stubbs hope the event will recharge the healthcare reform movement.

Doherty said he remains hopeful, considering this is the closest that Congress has ever come to passing healthcare reform. During the failed efforts of the 1990s, neither chamber ever passed a comprehensive bill, he pointed out.

Close isn't good enough, Stubbs said. Or, in his southern parlance, "close only counts in horseshoes." He said he remains "Pollyanna-ish" about the likelihood of reform passing.

But if, after the meeting the president has scheduled on reform next week, Congress is still unable to pass healthcare reform, the odds of it passing at any time during Obama's presidency are not good, Doherty predicted.

[humblegunner]

Oh, are you mandated to buy health care insurance, now?

Obviously not.

Or, if you explain your theory about phony titles well enough and often enough, I’ll bet your doc will allow you to choose all your own meds, from now on.

I doubt it.
I was reconstructed orthopedically in 1985.
In 2007 (or was it 2008) I had the lung-ebola stuff that they said
would kill me but didn't. I'm not often touched by "doctors" and never by choice.

You seem really pissed off that I have a different opinion than you.

Why is that? When I prefaced my remarks with "I don't like that service providers should have the government dictate reimbursment."

I am not in favor of government controlled healthcare.

I just think that ONE of the arguments against it is false.

Healthcare is NOT in the hands of the recipient, period.
Hell, we aren't even CONSULTED that I've seen. The heavy hand
of Big Brother either has a government title or a medical one.

What is the big difference? I still don't get to decide.

Look, doc.. we ALL have job titles.

Me, I'm an IATA certified Dangerous Goods Specialist. That means I can put explosives on planes.

Do I parade around waving this? Hell no.

"Doctors" do. I object to that. It's my opinion. Folks have those, you know?

For the record, I supported your position on the HPV issue and others.

I don't see why you are so pissed off at me.

[hocndoc]

I was trying to help you take charge of your medical decisions with out “doctors” interfering. You’ve found one: don’t let them touch you.

I bet you object just as strongly to titles like “sergeant,” and “general,” in the military.