Endocrine Insider
March 18, 2010

(See Full Issue)

Health Reform
Congress is expected to vote this week on a health care reform proposal originally passed by the Senate in December 2009. Because passage of health reform legislation has stalled over the past few months, Democrats are now rumored to be pursuing passage of the bill, the Patient Protection and Affordable Care Act, through a procedure known as reconciliation. Reconciliation requires only simple majority approval for passage, rather than the 60 vote super-majority normally required to end debate and move to a vote on the legislation. While the bill was originally passed by the Senate, the White House and the House have requested some changes to the legislation that Congress is in the process of incorporating. These changes require a vote by both chambers, and the House is expected to vote this week. Passage of the legislation will be especially challenging in the House, where it is unclear whether the 216 votes necessary for approval exist.

The Endocrine Society is closely following the debate on health reform in part due to a provision included in the Senate bill that addresses payment cuts to dual energy x-ray absorptiometry (DXA) services provided in physicians’ offices. DXA payments have been cut by 67 percent since 2007, and the proposal in the Senate health reform bill would restore payments for two years to 70 percent of the 2006 payment rate to approximately $98. The proposal also instructs the Institute of Medicine to perform a study on the impact on patient access to DXA services due to the cuts.

In 2009, The Endocrine Society developed a set of guiding principles for health reform outlining the Society’s key issues for inclusion in any health reform proposal. These guiding principles have been used as a basis for the Society’s communication with House and Senate leadership regarding the various health reform bills that have been proposed throughout the past year.

Physician Payment Cuts
Since the beginning of the year, Congress has passed a number of short-term legislative fixes in an attempt to stave off a scheduled 21.2 percent cut to Medicare physician payments. The cuts, which have been created by the flawed sustainable growth rate (SGR), the formula by which Medicare physician payments are calculated, were originally scheduled to go into effect on January 1, 2010.  However, Congress has repeatedly delayed the cuts as it attempts to find a legislative vehicle in which to include a longer-term fix to the SGR problem.

The most recent short-term fix was passed in early March and is scheduled to end on April 1. Last week, the Senate passed legislation that would again delay physician payment cuts until October 1. The bill now goes to the House for passage, where the inclusion of amendments will likely require both houses to vote again on the amended bill. As such, it is unlikely that both houses will be able to approve this most recent fix by the April 1 deadline to avert the scheduled 21.2 percent physician payment cut. If this is the case, CMS will likely instruct Medicare contractors to hold all claims for payment for a few days to give Congress an opportunity to pass the short-term fix. It is unlikely that Congress to will address a longer-term fix to the SGR this year.

The Endocrine Society continues to press Congress for a longer-term fix to the SGR and encourages its members to contact their members of Congress to express their disapproval and frustration with the current payment system.

Stay tuned to Endocrine Insider for new developments as they occur.