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Physicians take Medicare reimbursement battle to Senate


Once again, urologists are at the mercy of the politicians in Washington with a 10.1% average payment rate cut scheduled to take effect this month unless some way, somehow Congress once again comes to the rescue-and President Bush signs whatever legislation is passed.

As of early December 2007, lobbyists for physicians, including urologists, are negotiating with members of the Senate Finance Committee to secure a deal similar to legislation approved in the House of Representatives that would prevent that huge cut and replace it with positive .5% updates in 2008 and 2009.

The problem is one of politics, time, and money. The House rollback was contained in H.R. 3162, the Children's Health and Medicare Protection Act of 2007 (CHAMP), but many senators were reluctant to couple a Medicare physicians' fee fix with children's health legislation, and President Bush already had vetoed an earlier version of the children's health insurance bill.

In past years, cuts have been ordered by the Centers for Medicare & Medicaid Services as required by law, only to have Congress step in later and reverse its action. In 2007, CMS had to establish a mechanism to restore reimbursement to physicians who lost money from cuts ordered in 2006 that were rescinded by Congress early in 2007.

Alec Stone, AUA's new director of government relations and advocacy, was cautiously optimistic that the reductions would be rescinded. Noting that CMS had released its final rule calling for the 10.1% cut to take effect Jan. 1, 2008, Stone said, "It is AUA's hope that Congress will recognize this as detrimental to medicine and intervene before that time or correct the situation retroactively, as it has done in the past."

But, he added, "Under today's restrictive timeline, Congress is under great pressure, but recognizes the need for a physician fix."

AUA is part of a coalition of specialty societies, the Alliance for Specialty Medicine, that is working with the American Medical Association and other groups to reach a deal with the Senate Finance Committee. An Alliance source told Urology Times in early December that she was still "hopeful" that a solution could be worked out. Not only were they striving to reverse the 10.1% cut ordered by CMS and replace it with a modest increase, the physicians' groups were also asking Congress to dedicate new funding to the update "rather than the same old funding gimmicks" that they say only make the problem worse over time, the source said.

The House-approved CHAMP Act would deal with the issue at the heart of the negative updates, the Sustainable Growth Rate (SGR) formula, replacing it with separate targets for major health care components such as primary care and preventive services, imaging, and major procedures. Physician-administered outpatient drugs, a major concern for urologists, would be removed from target calculations.

Insiders report that Sen. Max Baucus (D-MT), finance committee chairman, supports the 2-year positive update, similar to the provision in the CHAMP Act. However, both Democrats and Republicans on the panel oppose cutting Medicare Advantage plans as one way to offset the cost, so there was an effort for a 1-year reprieve instead.

A study by the Congressional Budget Office (CBO) released in November projects that health care costs could comprise half of the U.S. economy by 2082, and suggests the growing cost of Medicare will be significantly larger than what Medicare trustees currently anticipate.

In fact, the study projected that federal Medicare and Medicaid spending, left unchecked, would rise from 4% of gross domestic product in 2007 to 7% in 2025, 12% in 2050, and 19% in 2082.

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