Organized Medicine Looks
to 108th Congress for Medicare Fee Schedule Relief
Michael Scott, J.D., Director
Governmental and Legal Affairs
ASA members are aware from the November
27
President’s Update by James E. Cottrell,
M.D., that the 107th Congress adjourned after a short
lame-duck session without taking action to provide
physicians with relief from the projected 4.4-percent
cut in Medicare reimbursement originally expected
to take effect January 1, 2003.
Fee
Schedule Chart Not Yet Available
Failure of the Department of Health and
Human Services to publish the 2003 Medicare
Fee Schedule rule prevents publication
in this NEWSLETTER issue, as
in past years, of the 2003 anesthesia
conversion factors by geographic payment
area. When the rule is published, this
data will be placed on the ASA Web site
and will also be published in the February
NEWSLETTER. |
|
As of the time this column is written, it is clear
that the effective date of the 2003 Medicare Fee Schedule
rule, reflecting the 4.4-percent cut (and any action
on ASA’s request for increased anesthesia work
values), will be delayed until after February 15.
This is because the rule has not yet been published
in the
Federal Register, and under the law,
it cannot take effect until 60 days after publication
— during which period Congress can, if it chooses,
reject it.
Since congressional adjournment, representatives of
organized medical groups have held extensive meetings
to attempt to determine the next step in dealing with
the Fee Schedule update problem. A window of opportunity
presents itself at the very beginning of the 108th
Congress because the government is currently operating
under a continuing resolution that expires in mid-January.
The new Congress is expected to convene on January
7 and, at the very least, must promptly pass another
continuing resolution to avoid a government shutdown.
It may in fact do more.
This need for congressional action, prior to the date
on which the 2003 reimbursement rule can legally go
into effect, suggests that the possibility for avoiding
the projected 2003 4.4-percent cut still exists. The
issue of precisely how to pursue this opportunity
is substantially more complex.
In the 107th Congress, the House tried successively
to deal with the cut in one of two ways. First it
passed legislation that would assure conversion factor
increases of 2 percent or more during 2003-05 but,
at the same time, postponed the budgetary impact of
these increases until 2006. This “solution”
simply exacerbates the existing problem brought about
by the terms of the Fee Schedule update formula and
by projection errors made by the government in calculating
the formula in 1998 and 1999, requiring the cuts of
5.4-percent in 2002 and the projected 4.4-percent
cut for 2003. Additional cuts loom in 2004 and 2005.
The House approach was actually included in a bill
introduced by Senators Charles E. Grassley (R-IA)
and Max Baucus (D-MT), but it went nowhere as it was
much too expensive from a budget perspective. In addition
to providing relief for physicians, it did the same
for many other provider groups, most importantly those
in rural areas. Both Senators come from rural states,
and because one is Chair of the Senate Finance Committee
and the other the Ranking Minority Member (their roles
reverse in the 108th Congress), their views are important.
As the 107th Congress drew to a close, the House leadership
decided to try another approach: it would provide
“cover” for the Administration to correct
the 1998-99 errors, by passing legislation assuring
that the Administration could not be sued for retroactive
payments if it corrected the errors. Correction of
the errors would technically “rebase”
the update formula, meaning that the need for a 2003
4.4-percent cut would be wiped out and, in fact, physicians
would get about a 1.5-percent increase for the year.
The second House effort fell flat in the Senate as
both Senators Grassley and Baucus blasted the approach
as “taking care of” the doctors’
problem without taking care of other providers, most
especially those in rural areas. Other rural state
senators were equally vehement in their opposition,
and needless to say, lobbyists for other provider
groups fed the fire — they knew that the physicians
have the strongest case for relief, and once they
are taken care of, there is little legislative steam
left for their clients.
Against this backdrop, the representative of organized
medicine must decide what course of action to recommend
to his or her respective organizations. Because it
appears likely that the GOP leadership in both the
Senate and House will attempt to move a Medicare prescription
drug benefit package later this year, with Medicare
reimbursement reform included for all providers, there
is the temptation to seek some “temporary”
relief in January. This could take the form of congressional
disapproval of the 2003 rule, which in effect would
freeze reimbursement at the 2002 level, or passage
of a one-year “fix” along the lines of
the first House bill, with budgetary impact delayed
until future years. The temporary nature of these
fixes might serve to placate Senators from rural states
who want to make sure that rural providers are eventually
assisted.
A good argument can be made, however, that the chance
of passage of a prescription drug/Medicare reform
package is speculative in a year when tight budgeting
will be the watchword and that an increased effort
should be made now to gain a more permanent solution
such as that passed by the House its first time around
last year. To a major extent, success in this respect
would turn upon a renewed commitment by the House
leadership to deal with this issue now that the leadership
in the Senate has changed.
Because of the substantial lead time involved between
reporting on developments and actual distribution
of the
NEWSLETTER, most ASA members will
not read this column until after the 108th Congress
has convened and acted on a continuing resolution.
Any significant developments will, however, be reported
to the membership by means of a
President’s
Update.
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