Congress passes short-sighted SGR-fix legislation:
Bill includes complex P4P provision,
Denies full funding to anesthesiology teaching programs
By a vote of 367 to 45 in the House, and 79 to 9 in the Senate, Congress passed H.R. 6111, a $40 billion tax cut bill that allows only a 0% update in physician payments for 2007, includes a complex and controversial pay-for-performance program, and rejects a provision that would restore full funding to anesthesiology teaching programs.
The legislation did not address CMS-mandated reductions arising from the Five Year Review and a new practice expense methodology. These adjustments still mean payment cuts for anesthesia services and are separate from the SGR issue addressed last week. Budget neutrality corrections will amount to an 8.9% decrease in the anesthesia conversion factor. Anesthesiologists perform many services besides anesthesia, such as line insertions, pain procedures and evaluation and management. Since payment for these services did not fall as much as for anesthesia care, total Medicare payments to anesthesiologists will drop about 7% next year, somewhat less than the conversion factor change would suggest. Before Congressional action on the SGR, anesthesiologists were looking at a 13.5% cut. The CF reduction and overall payment cuts will take effect Jan. 1, 2007, despite the SGR freeze provided through H.R. 6111.
In the face of these legislative disappointments, ASA will continue pushing Congress and the Administration for a long-term solution to the SGR problem and the serious payment disparity that affects anesthesiologists. Further, in the 110th Congress we will intensify our efforts to support legislation that would restore full funding to anesthesiology teaching programs. These changes are particularly urgent because of the downward spiraling anesthesia conversion factor, which will be lower in 2007 than it was a decade ago.
To ensure access to expert anesthesiology medical care for our nation’s seniors, the new Democrat-led Congress must address these pressing issues.
SGR
Despite the strong efforts of ASA and organized medicine to achieve positive Medicare updates, H.R. 6111 includes a short-term, inadequate “patch” to the flawed Sustainable Growth Rate (SGR) formula. The bill includes a provision to allow only a 0% update in physician payments for 2007, along with possible 1.5% bonus payments in the second half of the year for participation in a controversial pay-for-performance program. This action averts a scheduled 5.0% cut for 2007.
While ASA had pushed for a positive update in 2007, it acknowledges that a payment freeze is more desirable than additional payment cuts. ASA will continue urging Congress to replace the SGR formula with a more reasonable update mechanism based on practice cost increases.
Further, in the coming legislative year we will refocus our efforts to address the outrageous level of CMS mandated cuts impacting all hospital-based physicians, particularly anesthesiologists.
This focus will be especially important in light of a staggering Medicare payment cut of approximately 10% set to take effect in 2008. H.R.6111 requires that Congress pay for this year’s payment freeze next year, effectively doubling payment cuts that anesthesiologists and all physicians will face in 2008. This cut will be on top of the grossly insufficient national unadjusted Medicare anesthesia conversion factor, which is scheduled to fall to $16.19 for 2007, from $17.76 in 2006.
This is the fifth consecutive year Congress has been forced to intervene to stave off Medicare physician payment reductions mandated by the unworkable SGR formula. By neglecting to enact a permanent solution to the Medicare payment problem and short-funding next year’s fix, Congress is creating an increasingly perilous situation in which our nation’s most vulnerable populations will soon face severely diminished access to quality medical care.
Pay-for-Performance
The payment language in H.R. 6111 includes pay-for-performance provisions that are dependent on the recently published Physician Voluntary Reporting Program measures for 2007, which include anesthesiology starter measures. Based on the complicated eligibility formula, qualified anesthesiologists and other physicians may earn an added 1.5% bonus on payments in the second half of 2007, subject to an overall program limit.
ASA continues reviewing the complex provisions for their implications to anesthesiology. (For an excerpt of the CRS summary, please click here.)
Medicare Anesthesiology Teaching Rule
Despite thousands of phone calls and emails from ASA members, countless meetings with Members of Congress and their staff, and scores of supportive Representatives and Senators, ASA is greatly disappointed that Congress did not pass Medicare Anesthesiology Teaching Rule reform legislation, H.R. 5246/H.R. 5348/S. 2990.
Over the past several months, ASA has strategized with key Members of Congress and the various committees of jurisdiction to move Teaching Rule bills this year. Initially, anesthesiology teaching rule reform language to restore full funding was included in the Senate version of the bill. However, in an eleventh-hour move and despite commitments to the contrary, some in Congress stripped the provision from the final version of the mammoth tax and health bill.
Still, we have accomplished extraordinary progress on this crucial legislative initiative this year. In only seven months, ASA members and staff continued to meet and discuss the teaching rule issue on a regular basis with key Members of Congress, resulting in the introduction of an unprecedented three bills cosponsored by 143 Representatives and Senators. Because of our efforts this year, we are extremely well-positioned to advance Medicare Anesthesiology Teaching Rule reform legislation in the 110th Congress.
Until Congress acts, however, hospitals and programs must continue subsidizing care for Medicare patients, rather than receiving fair payment from CMS for the services of teaching anesthesiologists. These programs have already suffered under the unfair 50% payment penalty for 12 years.
It is disappointing that Congress and CMS are holding fast to policies that harm our ability to train new anesthesiologists, who provide expert medical anesthesiology care to our nation’s most vulnerable populations. Further, it is unconscionable that one non-physician group would continue spreading false information attacking a bill that in no way harms—or in any way affects—its wholly separate teaching programs.
Despite this setback, ASA will redouble its efforts to seek and support proposals that will help sustain academic anesthesiology programs throughout the country. When the 110th Congress convenes in January, ASA will continue pushing for a legislative fix to the 50% payment penalty, which harms anesthesiology teaching programs alone and in no way affects other physicians or non-physician healthcare providers.
Incoming House Majority Leader Steny Hoyer (D-MD) has indicated that Congress will work more days next year—as opposed to a record low number of days in 2006—providing additional time to seek legislative relief from the egregious payment penalty. Further, ASA is well-positioned to work alongside the incoming chairman of the House Ways and Means Health Subcommittee, Fortney “Pete” Stark (D-CA), who was the chief sponsor of H.R. 5348.
For vote information, please use the following links:
House
Senate