Bill Fails to pass the Senate to Abate Medicare Pay Cuts

Doctors Face Payment Cuts for Patients on Medicare – Bill fails to pass the Senate

They are in recess until after the 4th of July so perhaps some action could be taken after the holiday that could be retro-active.  The ones that will benefit will be the insurers, who are busy opening up offices in China. BD 

WASHINGTON — Doctors face a 10 percent cut in Medicare payments next week, following the Senate’s failure on Thursday to take up legislation that would have averted the cuts.

Republican senators blocked efforts by Democrats to call up the bill, which was approved Tuesday in the House by an overwhelming bipartisan vote of 355 to 59.  In the Senate, supporters fell two votes short of the 60 needed to close debate. The vote was 58 to 40.  Senator Richard J. Durbin of Illinois, the Democratic whip, said: “Who supports this bill? Doctors, consumer groups, pharmacists, hospitals. Who opposes this bill? The health insurance industry and the White House.”

President Bush had threatened to veto the bill, in part because it would reduce federal payments to private Medicare Advantage plans, offered by insurers like Humana, UnitedHealth and Blue Cross and Blue Shield companies.

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I dont know if posting this .jpg will cause some sort of positive feeback loop for google ads causing Nick to get rich but I like experimenting anyway.

 Medicare Rates Will be Cut 10.6 Percent on July 1, as Senate Fails to Pass Fee Fix

Senate Democratic leaders fell one vote short in their effort this evening to pass the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331). This means the 10.6 percent Medicare physician payment cut WILL go into effect on Tuesday, July 1. Some kind of fix could pass in the coming weeks, but in the meantime, CMS will implement the cut. The Academy will provide further information and guidance in the coming days, as the situation evolves.

Senate Democrats were joined by Republicans Elizabeth Dole of North Carolina, Olympia Snowe of Maine, Gordon Smith of Oregon, Pat Roberts of Kansas, Norm Coleman of Minnesota, Susan Collins of Maine, Ted Stevens of Alaska, George Voinovich of Ohio and Lisa Murkowski of Alaska. The final vote was 58 to 40, with 60 votes needed to pass this legislation. Senate majority leader Harry Reid, D-Nev., changed his vote to no for procedural reasons. Reid stated that the Senate will vote again on H.R. 6331 after Sen. Edward Kennedy, D-Mass., who was absent for the vote this evening, returns to the Senate following the July 4 recess.

Once again I'll have to stop seeing a group of patients to save my practice.  I will have to delay the acceptance of new Medicare patients and existing patients will experience reduced servces.  It is akin to cutting off your arm to save your life.  I hope physicans will use their power to save the professsion.  Fortunately, I have found that every time I rejected a bad insurance, the practice has rebounded stronger.  Patients who have left because I won't particpate in Medicare Advantage programs seem to return when the realize that there is not much advantage for them.

Queston:  Has anyone received the pay for performance bonus Medicare offered last year for reporting.  I opted out this year because it was more work and did not improve the care for my patients.  I am also suspecious as to what tactics insurers would use to reject payments.

I received $1,000 a few weeks ago.

 I think it's fantastic.  It's the anti-trust end-around doctors have needed for the last 20 years.  I suspect millions of primary care doctors will join me in closing their offices to new Medicare patients Monday morning.  The AMA doesn't have much pull on Capitol Hill, but watch what 5 million retirees who paid into Medicare all their lives but now can't get a doctor can accomplish.

No cuts for now.

Frozen for few days in summer.

Got to do something upon thaw to avoid cuts.

Yellers can be good politicians too.

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/27/AR2008062703230.html

We plan to pull the plug on our Medicare participation.  It takes my staff hours to go though the filing & appeals process for a fraction of our fee.  Sadly, it just isn't worth it.

It really bothers me to see physicians getting squeezed like this and I hate to see this rate cut go through. It could easily have a negative impact on EMR adoption rates and I am offering personal assistance for physicians that plan on implementing EMRs. Any practice with 1-2 providers that plan on transitioning to an EMR can have me setup their LAN for a fixed rate of $300 (no hourly fluxuations based on unforseen problems!).

I have seen many IT professionals struggle through setting up a basic LAN and it costs the physician on a per hour basis, typically $75/hr to $150/hr. You can accurately budget what it will cost for your LAN to be setup and limit the headaches caused from an improperly setup LAN.

Limitations:

Most importantly, this is done only during my time -not regular business hours

The office will have local IT support as this is not an on-going support offer

Phone calls, questions, emails and general setup discussion will only be done M-F after 5:30 and on the weekends after 9AM

1-2 provider office for NEW setups only (I will not analyze an existing network/server setup from afar and try to work around the current setup, that could easily turn into an awful mess for both of us)

Will not install Norton!!!

Currently, only available from July to August of '08 (might extend this offer, will be determined at a later date)

Offer includes:

Install/setup of a Windows server environment (SBS 2K3 Premium Edition or Basic)

SQL Server 2000 or 2005 which I will need to know some information from your chosen EMR vendor such as Windows authentication vs. SA authentication

Faxing capability included with SBS 2K3

Backup devices configured with SBS 2K3 backup

Router setup (IT professional might have to "clean up" WAN settings to obtain internet connectivity) -I recommend Netgear b/c it offers an easy interface for the user to setup themselves

Scanner setup

Printer setup

Dragon Naturally Speaking installation on the physician's PC

Basic PC setup (tablets included)

Setup of CA as the anti-virus, if you choose Norton I'll let you deal with those headaches :) -in other words, Norton is not included in the offer.

General quality assurance (all PC's see eachother, the server, scanner scans, printer prints, etc).

This will give small offices a basic LAN with necessary components in place for you to install your selected EMR. All PC's will "see" the server and the server will "see" the PC's. Printing and scanning will work as expected as will backup devices.

Everything will be shipped to your office ready to plug in and have your local IT support take over from there. Documentation will be provided for the work completed and I will label cords/cables for each piece of hardware.

I want to do my part to ease these recent cuts and I hope this will assist small offices. I have done this many times before and it works very well. It normally costs significantly more because it can easily take a week or so to get everything installed, tested and working properly but I want to help the small offices hurt by these rate cuts.

Based on previous experience, it will cost somewhere around $100 to ship the equipment back to you. I think physicians will be hard pressed to find a better all around price for the quality of the service.

Please send me a private message and I can send you my cell phone number for further discussions.

Update: put a couple short comments from here at the blog as I covered as many related links...

Temporary Halt To Medicare Reimbursement Cuts – HR 6331 Update stalled until July 15th – The shot heard round the country…Loud and Clear in Texas…

Somebody had to step up the plate here, so the deadline is extended to July 15th now.  In a related story:  from the Center for Medicare Advocacy

“One day after the Government Accountability Office reported that private Medicare Advantage plans made $1.14 billion more in profits than they had projected, Senate Republicans used the excuse of protecting these plans to defeat Medicare legislation that would prevent a pay cut for doctors from going into effect and that would add more assistance for low-income older people and people with disabilities.”

More here from the American College of Physicians….

GruntDoc states both Texas Senators chose to screw the docs…

The Texas Medical Association Backs off support for Cornyn

By the end of the day, the association's political committee,  TEXPAC, had withdrawn its backing of Cornyn, saying its board was "outraged."….But the Senator states here that Democrats chose political games over protecting Medicare…

Kevin, MD has a You Tube Video on Big Bad John….

Earlier the AMA spoke out….Congressional confidence at an all time low….

Read some reactions of how some physicians feel about this…and they are not happy…from EMR Update….”We plan to pull the plug on our Medicare participation”…”Many may join me in closing the office to new patients”…and so on, it’s about patient access as well…BD 

The House of Representatives clearly did their part….

U.S. Congressman Phil Gingrey, MD (R-GA) is pleased to announce that despite the Senate's failure to pass House-approved legislation to prevent a 10.6% cut to physicians' Medicare reimbursement, the Centers for Medicare and Medicaid Services (CMS) will effectively delay the scheduled cuts until at least July 15th - giving Congress time to address these cuts after the July 4th recess.

Earlier this week, Congressman Gingrey voted for a bill to prevent the automatic 10.6% cut to physician reimbursement which passed the House. Though the legislation failed in the Senate, the Democratic leadership chose to adjourn the House of Representatives for the Fourth of July recess with no announced plans to reconvene. In response to inaction by Congress, CMS announced it will instruct contractors to not process any physician and non-physician practitioner claims for the first 10 business days of July, in accordance with existing law. This delay should give Congress additional time to enact legislation to prevent these cuts on a more permanent basis.

Nice thread guys! Since I'm currently out of the country, I've been trying to find the particulars on the HIT legislation, and now I have it.

Question: does anyone know about the status of the HIT tie-in? I hope that they don't pass a bill that only gives the 10% pay cut back to those who own an "enterprise" CCHIT certified EHR. This would only then be a smoke-and-mirrors bill, still forcing the 90% of small practices who don't have such an EMR to drop Medicare.

Update from the blog...

Senate Democrats Attack Republicans on Medicare - “There will be blood” (HR3661)

One senator wonders at this point why he is a Republican…and the Democrats were quick to have the names of those who voted against the bill, and it was published  immediately on the web.  Mr. Leavitt has stated he would hold new claims for 10 business days so doctors would not see the lower payments, which is good after the last incident posted a short while back where a federal judge had to step in and slap down the sneaky attempt to push the Medicaid cuts through at the end of May as they attempted a “type ridden final rule” filing in the Federal Resister before Congress could act, so hopefully with the 10 day agreement, this won’t happen again.  So until the matter is cleared, no payments for 10 days.  BD 

Democrats moved swiftly on Friday to assail Republican senators for voting against a major Medicare bill and said the Republicans should be held responsible for a 10 percent cut in payments to doctors that takes effect next week.

And doctors, pharmacists and advocates for Medicare beneficiaries said they would step up pressure on members of Congress when they return home for the Fourth of July recess.  In nearly identical terms, Democrats attacked seven other Republican senators: Lamar Alexander of Tennessee, John Barrasso of Wyoming, Saxby Chambliss of Georgia, John Cornyn of Texas, James M. Inhofe of Oklahoma, Mitch McConnell of Kentucky and Roger Wicker of Mississippi.

Michael O. Leavitt, secretary of health and human services, said he hoped to “minimize the impact” of the cut. Medicare said it would hold new claims for 10 business days, so doctors would not see the lower payments “until July 15, at the earliest.”

Joseph P. Lech, who owns five drugstores in northeastern Pennsylvania, said he was surprised and disappointed to see that Senator Arlen Specter, Republican of Pennsylvania, had voted against a motion to take up the bill, which would speed payments to pharmacies. “I’ve been a registered Republican for almost 30 years, but I am beginning to wonder why,” Mr. Lech said.

One of the great advantages of implementing a comprehensive EMR/PM system is that we have become a low-cost provider.  The Medicare cuts will probably be beneficial for this practice.

How on earth can this be?

Simple.  Medicare patients, since they are older, require more biopsies and skin cancer surgeries than a typical younger patient.  And I'll make a lot more money performing biopsies than treating acne or rashes.  If local dermatologists decide to not accept Medicare anymore, my patient mix will greatly improve.  If you drop Medicare, don't expect those patients to come back when you change your mind - security is everything to these folks.

I'm all for the Medicare Advantage plans, too.  They pay us  faster Medicare, and they reject claims less, too.  I don't see why their reimbursements are being cut.  They do a better job of processing claims.

Maybe the situation is different for dermatologists.  Perhaps I lead a charmed life.  But I would love to do more than the typical 5 surgeries a day.  And I love the interaction with the older folks.  I would love to have 90% Medicare patients on my schedule.  Even at reduced rates.

dagmar:

One of the great advantages of implementing a comprehensive EMR/PM system is that we have become a low-cost provider. 

I wish you would start a new thread to explain HOW implementing EMR/PM enabled you to become a low-cost provider. Could you help us see the connection, how EMR helped this come about? Great post, by the way!

dagmar:

'm all for the Medicare Advantage plans, too.  They pay us  faster Medicare, and they reject claims less, too.  I don't see why their reimbursements are being cut.  They do a better job of processing claims.

I have a group of three providers that are in the same camp.  They only use Medicare and avoid all insurances.  There argument is that they don't get paid much, but they do get paid.  They don't have the normal Billing issues associated with private carriers, and they are happy.

In South Florida they have mostly elderly patients, and they require a lot of visits.  So I guess if the demographic is right, then Medicare is a great thing.

Dagmar, I cannot see how the 10% cut is good for anyone, however, as the access to PCP is extremely hard here in South Florida.  Therefore, the cost is in the Health Care Providers not being available to those who need them because they are off becoming a specialist.

Opting out can have some negative implications. First, I believe you can't come back for 2 years. Also, there is the PR issue but that varies based on your circumstances. There is also one's philosophy but that is a personal choice.

For me, I will stay w/Medicare in hoped that tis will get "fixed".