Medical Device Daily Washington Editor

Physicians who render services for fees under Medicare Part B have been up in arms for months over the proposal by the Center for Medicare and Medicaid Services to trim reimbursement by 5.1%. And if recent remarks by the chairman of the House Energy and Commerce Committee are any indication, Congress is definitely tuned in.

However, Congress will have to paddle through any such fixes after the election.

At a Sept. 13 press conference, Cecil Wilson, chairman of the American Medical Association (AMA; Washington) said that he would lead a group of physicians to Congressional offices to argue the fallacy of the proposed cuts under the sustainable growth rate (SGR) approach (Medical Device Daily, Sept. 15, 2006) and urged that Congress address the situation immediately.

“We believe it’s critical that this happen before the election,” Wilson said.

At that time, Bill Thomas (R-California) proposed tying a rollback of those cuts to a rewritten estate tax cut bill, H.R. 5638, but the effort went nowhere and the AMA threatened a public information campaign intended to have candidates squirming on their daises during campaign rallies.

Testifying before the Energy and Commerce’s health subcommittee, full committee chairman Joe Barton (R-Texas) said Thursday that he favors “totally scrapping the SGR system and holding doctors harmless for that provision.” Barton said that the SGR numbers were “kind of funny-money anyway” and that Congress should “wipe it off the books and start from scratch.”

Barton suggested that the legislation could be knocked out within 45 days, but Rep. Charlie Norwood (R-Georgia) had no problem with a longer timeline.

“It’s all right with me if it’s Christmas Eve” when the effort is culminated, Norwood said.

However, Nathan Deal, the subcommittee chair, stuck to the view that proponents of any such plan would have to locate offsets to avoid a further expansion of the federal budget’s girth. He said such offsets will not be easy to locate, but added: “So what if it’s hard?”

Ranking minority member John Dingell (D-Michigan) suggested one source of offsets, arguing that there is “absolutely no reason that HMOs should receive more generous payment than a senior’s doctor.”

Deal seconded that idea, saying that “HMO’s have to cough up some.”

Deal’s attitude on offsets has pervaded much of the subcommittee’s thinking this year. He said that offsets would also have to be found for proposals to restore reduce physician fees for imaging services encoded in the Deficit Reduction Act of 2005 (MDD, July 20, 2006), but the bill that would have restored those cuts, H.R. 5704, died in committee despite bipartisan support.

In a plan suggestive of pay for performance, Barton hinted that if Medicare doctors want to keep their money, they would have to show improved outcomes and more efficient use of resources.

“I’m prepared to put on the table a multi-year approach that holds physicians harmless, at a minimum, and provides incentives for some additional payments based on what physicians themselves voluntarily do to advance quality and efficient care,” Barton said. And he proposed boosting physician fees by half a percentage point in each of the next three years — plus another quarter-point if they participated in a local utilization management program as well as any one of three other care index programs. Among these are reports to Medicare on quality of care and coordination of care by the primary care physician.

House, Senate HIT bills also left for lame duck

Healthcare information technology also failed to get in under the wire in last week’s last-gasp drive to pass bills before the election break.

A number of congressional staffers appeared at the Healthcare Information Technology Summit in Washington last week to discuss the differences between the Senate and House bills, but insisted on speaking off the record.

The staffers offered varying degrees of optimism and pessimism regarding the chances of finding a way to fuse S. 1418 and H.R. 4157 prior to the end of the regular session. Various comments constituted parries and riposts over the major themes of privacy and financing for HIT, but other controversies also surfaced.

One of the panelists commented that open-source software was the better way to handle some of the interoperability question, but others felt that the time and money invested by firms in the business of building software for electronic health records and electronic prescribing deserved consideration.

“We’re not seeing hospitals use software as a competitive weapon,” one of them observed.

In any case, Congress simply ran out of time to come up with a HIT bill. At 4:15 last Friday, Kevin Madden, the press secretary for House majority leader John Boehner (R-Ohio) told MDD that there was “very little chance of getting agreement before we leave tonight.”

Judge: no to collecting Part D overpayments

Thanks to a ruling by a judge in the U.S. District Court for Washington, the consequences of a computer glitch that cost the Centers for Medicare & Medicaid Services (CMS; Baltimore) tens of millions of dollars are a day closer to becoming permanent pay-outs.

In a lawsuit filed against CMS by the Action Alliance of Senior Citizens (Philadelphia) and the Gray Panthers (Washington), Judge Henry Kennedy Jr. issued a ruling last Thursday that blocks the efforts to pull back roughly $50 million in erroneous Medicare Part D refunds.

Kennedy ruled that CMS must immediately send a notice to each of the affected beneficiaries that they have a legal right to apply for a waiver. About 230,000 people got erroneous refunds at an average of about $215 each.

Kennedy also ruled that the agency must return the refund checks to any beneficiaries who returned them to CMS so that they can apply for the waiver.

Gill Deford, an attorney at the Center for Medicare Advocacy (Willimantic, Connecticut), said “[t]he judge did the right thing,” noting that courts “said 20 years ago that beneficiaries have to be informed of their right to a waiver when they receive an incorrect payment.”

CMS spokesman Peter Ashkenaz said Thursday that the agency is reviewing the ruling. “Our main goal remains making sure that these beneficiaries continue their drug coverage with the least inconvenience possible, and we intend to continue to do everything possible to achieve that goal,” he said.

Ashkenaz told MDD that Leavitt “does not believe that the waiver provisions of the Medicare statute apply to this situation, which involved the erroneous refund of 230,000 enrollees’ Part D premiums. The Medicare statute only authorizes waivers for overpayments of “items or services” and the refund “of a premium that the beneficiary [was] already paid clearly is not an overpayment of an item or service.”