AUA to Congress: Stop playing games

Apr 01, 2010

Finding a solution would seem to be a core issue for those interested in reforming a health care system in which Medicare is such a core component.

On March 2, the congressionally mandated 21.2% rate cut caused by the sustainable growth rate (SGR) formula was delayed once more, following a hotly contested Senate battle spearheaded by Sen. Jim Bunning (R-KY), who was blocking efforts to pass the bill containing the extension. The cuts were to take effect April 1.

But then, apparently tiring of his holdout, Bunning capitulated and voted for a 1-month extension, once again providing some breathing room for lawmakers to deal with this issue that never gets dealt with.

Ironically, all of that happened following President Obama's televised Health Care Summit, which featured 7 hours of political posturing by the president and lawmakers, but little negotiating about health care reform. And during those 7 hours, I did not hear a word of discussion about the need to find a solution to the SGR and the recurring Medicare fee cuts that Congress keeps delaying year after year.

As Karen Lencoski, JD, MBA, AUA's government relations and advocacy manager, told us, "If we are going to do health care reform, let's do health care reform. If we don't do anything about this old, flawed system, what are we actually reforming?"

Certainly, finding a solution would seem to be a core issue for those interested in reforming a health care system in which Medicare is such a core component. But the politicians are afraid to add the estimated $210 to $240 billion cost into the already excruciatingly high cost of more than $900 billion over 10 years estimated for the Senate's approach, upon which President Obama seems intent to build. They just can't handle it.

But the problem isn't going to go away simply by ignoring it. On March 10, the Senate voted to delay the cut for another 7 months-until October-to buy time to find a more permanent solution. At press time, the House had yet to take up the issue.

"Certainly, a temporary fix is better than a 21% cut," Lencoski acknowledged. "But if you are only going to do a 7-month fix, that's not kicking the can down the road; that is flipping the can. If it keeps going farther out, the cost is only going to go up. The problem is only going to get worse. They need to stand up and do what needs to be done to fund the system."

AUA's call to action

On Feb. 26, AUA sent an "Action Alert" to members explaining that the cut would effectively take effect because the Senate was unable to pass the temporary extension by unanimous consent due to Bunning's objection that the $10 billion cost of all of the program extensions in the legislation was not offset by reductions elsewhere.

However, AUA noted that the Centers for Medicare & Medicaid Services was notifying contractors to hold Medicare physician claims for 10 business days, effective March 1, anticipating the extension by Congress. The agency reportedly sent similar messages to physicians themselves. With only a 30-day extension, that action may need to be repeated late in April if it appears another extension is in the offing.

Meanwhile, AUA urged its members to express their "outrage to Congress about its terrible mismanagement of the Medicare program, which is so important to the health and well-being of our older Americans."

AUA had its own talking points for the politicians, namely:

No doubt, by the time you read this, another temporary extension will have been passed one way or another, and Congress will breathe a big sigh of relief, having gotten doctors off their backs for a while, and will go about their business trying to figure out how to reform health care.

And then, 7 months from now, there will be yet another "doc fix" crisis, when Congress will probably flip the can one more time.

Bob Gatty, a former congressional aide, covers news from Washingtonfor Urology Times.