Medicare pay held so Congress can undo 21% cut

CMS is delaying claims processing until April 14. Meanwhile, President Obama is tapping a quality improvement expert to head the agency.

By Chris Silva — Posted April 5, 2010

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For the second time in as many months, Congress failed to prevent a 21% cut in Medicare physician rates from taking effect after lawmakers were unable to agree on legislation to enact another short-term payment patch.

Senate Majority Leader Harry Reid (D, Nev.) could not obtain unanimous consent during debate on the Continuing Extension Act of 2010 on March 25 and March 26. Sen. Tom Coburn, MD (R, Okla.), blocked consent, saying the nearly $10 billion measure should be offset. The bill would have delayed the 21% Medicare pay cut from April 1 until May 1.

Reid filed a cloture motion to force a vote, but the Senate ran out of time to schedule it before starting its two-week recess. The next chance to consider the legislation, which also would extend long-term unemployment benefits and health insurance subsidies for jobless workers, will be after Congress reconvenes April 12.

Doctors might never experience the effect of the 21% cut. When the Senate recessed without acting on the 30-day delay, the Centers for Medicare & Medicaid Services instructed contractors to avoid processing Medicare claims for 10 business days. If Congress approves a pay patch soon upon its return and makes the measure retroactive, doctors will not see any Medicare checks with pay cuts.

Dr. Coburn's objection was only the latest breakdown in progress on the Medicare pay issue. Just before lawmakers recessed, a bipartisan group of senators floated a one-week extension as a compromise, but House Democrats rejected that proposal. The House had passed the Continuing Extension Act on March 17, but did not act on a separate Senate-passed bill to delay the Medicare rate reduction until Oct. 1, citing a disagreement between the chambers over how that bill would be funded.

The fact that lawmakers once again allowed the 21% Medicare payment cut to take effect is unacceptable to the American Medical Association.

"Members of Congress eager to spend a two-week holiday with their families have left America's military families and seniors to fend for themselves through their inaction on a known threat to the Medicare and Tricare programs," said AMA President J. James Rohack, MD. "One month ago, when Congress delayed this year's 21% cut to April 1, we urged them to use this time wisely to repeal the payment formula that projects these cuts. It is unconscionable for elected officials to play politics with seniors and military families who rely on them to preserve their ability to see the physician of their choice."

Dr. Rohack renewed the Association's warning that the payment cut would lead many physicians to limit the number of Medicare patients they see. He reiterated that physicians are tired of short-term patches and want Congress to approve a permanent repeal of the sustainable growth rate formula.


Donald Berwick, MD

The inability of Congress to reach an agreement to postpone the Medicare pay cuts and extend benefits for unemployment and health assistance programs left lawmakers on both sides of the aisle pointing fingers.

Dr. Coburn accused Democratic leaders of trying to set a precedent of not paying for benefits extensions. "The American people and the rest of the world understand that our debt and deficits are as much of an emergency as our unemployment rate," he said. He argued that the bill should be funded with unspent stimulus package money, and he chided House Democrats for not passing the one-week extension consensus.

House Democrats shot back that Dr. Coburn placed Congress in a difficult position by demanding offsets for benefits extensions that normally have been classified as emergency spending -- and thus not subject to pay-as-you-go rules. They compared his actions to those of Sen. Jim Bunning (R, Ky.), who in February repeatedly objected to unanimous consent requests to approve the legislation that eventually pushed the Medicare pay cut deadline to April 1.

New CMS chief?

As Congress continues to debate Medicare payment issues, the White House is moving to put someone in place to run the program.

White House officials indicated March 27 that Obama will nominate Donald Berwick, MD, as CMS administrator. The agency has been without a permanent administrator since October 2006. The nomination will require Senate approval.

Dr. Berwick, a pediatrician, is president and CEO of the Institute for Healthcare Improvement, a Cambridge, Mass., nonprofit organization that promotes concepts to improve the quality of patient care. Dr. Berwick is also a clinical professor of pediatrics and health care policy at Harvard Medical School.

Health care organizations described Dr. Berwick as a good choice for the job.

"Dr. Berwick is widely known and well-respected for his visionary leadership efforts that focus on optimizing the quality and safety of patient care in hospitals and across health care settings," said AMA Immediate Past President Nancy H. Nielsen, MD, PhD. "The AMA partnered with Dr. Berwick's Institute for Healthcare Improvement in many of those efforts, and we look forward to working with him at CMS on implementation of the new health reform law and on ensuring that physicians can keep caring for seniors who rely on Medicare."

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