Medicare physician pay cut delayed until March

Washington -- President Obama has signed legislation that would prevent a 21.2% Medicare payment cut from taking place Jan. 1 by freezing physician rates for two months.

The temporary patch, which expires after Feb. 28, 2010, is intended to give Congress additional time to craft a more lasting solution to the doctor pay problem. It piggybacked on the fiscal 2010 appropriations bill for the Defense Dept., which helps fund the wars in Afghanistan and Iraq. The White House announced Dec. 21 that the president had signed the legislation.

The temporary extension of 2009 rates for Medicare physicians was a necessary move by Congress, said American Medical Association President J. James Rohack, MD. "As we call for a permanent solution, the AMA acknowledges the House and Senate votes to stop the cuts for two months so that access to care for Medicare and Tricare patients is not disrupted while the Senate works on solving the problem once and for all."

The House already has approved a long-term payment reform bill that would align physician rates more closely with the costs of providing care, but Senate Democrats were unable to muster enough support to approve a similar bill in the upper chamber earlier this year. The Senate health system reform bill had included a provision that would patch the pay system for one year, but leaders removed the language before bringing up the final package for a Senate vote.

HHS agencies receive boost for 2010

A separate HHS spending bill was part of a $447 billion package of six appropriations bills Obama signed Dec. 16. The House adopted the package 221-202 on Dec. 10. The Senate followed suit in a weekend session by voting 60-34 on Dec. 12 to end debate on the spending package, which it then approved by a 57-35 vote on Dec. 13.

The fiscal 2010 Labor/HHS bill has $8.5 billion more in discretionary spending than in 2009, for a total of $163.5 billion, according to Senate Appropriations Committee figures. Some of the most significant spending increases in the HHS bill will support biomedical research, immunizations, infection prevention and a new teen pregnancy prevention program.

The federal fiscal year 2010 began Oct. 1, but Congress twice adopted continuing resolutions extending government funding at 2009 levels. The second extension would have expired Dec. 18.

House Minority Leader John Boehner (R, Ohio), among other Republicans, said the spending bill is more evidence that Congress needs to tighten its purse strings. "We're broke! America's broke!" Boehner said on the House floor Dec. 10. "When are we going to say enough is enough?"

Sen. John Thune (R, S.D.) noted, also on Dec. 10, that Congress "has generated a $1.4 trillion deficit in less than 12 months." At some point fiscal restraint must return to Washington, D.C., he said. "We haven't seen it here in far too long."

But Rep. David Obey (D, Wis.), chair of the House Appropriations Committee, said the Bush administration is responsible for much more of the $12.1 trillion federal debt than is the Obama administration.

Tough times in 2011?

The HHS funding increases, though moderate overall, may seem generous compared with the fiscal 2011 budget proposal the Obama administration is working on, according to Scott Lilly, a senior fellow at the Center for American Progress, a liberal think tank. Lilly said agency directors told him the initial White House budget proposals for 2011 are "pretty disturbing. It's going to be a tough year next year." Obama's budget proposal is due in late January or early February 2010.

The National Institutes of Health is receiving a $692 million increase in 2010, 2.3% more than 2009 levels. This will allow the institute to fund thousands of new research grants, according to Jennifer Zeitzer, PhD, director of legislative relations for the Federation of American Societies for Experimental Biology.

But the NIH's financial outlook for 2011 is less promising and parallels a dilemma faced by much of the federal government. The NIH budget recently has been flush, largely thanks to the $787 billion stimulus package enacted in February. The NIH received $10.4 billion worth of stimulus funding, but that money runs out at the end of 2010.

FASEB President Mark O. Lively, PhD, said the risk is high for stalled research. "Newly funded research projects will be halted, and jobs will be lost. Furthermore, productive careers will be cut short, and critical scientific opportunities will be missed."

Even this year's NIH increase could be eclipsed by the cost of conducting biomedical research, projected to increase by 3.3% in 2010, as measured by the Biomedical Research and Development Price Index. The Dept. of Commerce's Bureau of Economic Analysis calculates the projections, last updated in February 2009. FASEB had asked for a 7% increase in the 2010 NIH budget, Zeitzer said.

Preventing infections, teen pregnancy

The 2010 HHS spending bill also significantly increases spending to prevent teenage pregnancy. The measure includes $114 million to establish a new evidence-based program for teen pregnancy prevention.

The HHS assistant secretary for health will oversee the newly formed Office of Adolescent Health, which will "support and expand teen pregnancy prevention efforts while also addressing a broader range of adolescent health issues," department spokeswoman Dori Salcido stated in a Dec. 18 e-mail.

The HHS bill also doubles federal support to $34 million to research and train health professionals on methods to prevent health care-associated infections. The Agency for Healthcare Research and Quality will administer the grants, which have supported pilot projects across the country, including a Michigan effort that sustainably reduced central-line bloodstream infections. "A lot of our focus now is expanding that throughout the country," said Jeff Brady, MD, MPH, the patient safety portfolio lead for AHRQ.

Other significant provisions in the HHS bill include:

• A directive for HHS and the Dept. of Labor to create an interagency task force to address health care work force needs.
• A $128 million increase for Centers for Disease Control and Prevention programs, including $36 million to increase HIV testing and treatment and a $30 million increase for cancer prevention.
• A $7.5 million increase for Dental Health Improvement Act state grants. States can receive a 60% federal match on a wide variety of projects to improve access to dental care, including mobile units and education loan repayment for dentists.