Endocrine Insider
December 10, 2009

(See Full Issue)

The Senate began debate November 30 on the “Patient Protection and Affordable Care Act” (HR 3590), addressing a small number of amendments during the first days of debate.  The bill includes a public option that allows states to opt-out, eliminates the limitation on coverage of those with pre-existing conditions, establishes an Independent Medicare Advisory Committee to determine Medicare payment policy, and eliminates the 21.5 percent payment cut on physicians’ services scheduled to take effect January 1, 2010, instead providing a 0.5 percent increase.  HR 3590 also includes a provision to address the DXA payment cuts that affect scans performed in physicians’ offices, setting the payment rate around $98 (70 percent of the 2006 level of $140) for two years.  As reported in previous editions of Endocrine Insider, the Society and a number of other specialty societies have been working for the past two years to identify a fix to these payment cuts.

Negotiations continue on contentious issues such as the public option, but Senate Democratic leadership is intent on holding a vote on HR 3590 before the end of the year and has suggested that the Senate will remain in session over the holidays if necessary.

Although HR 3590 addresses the issue of the Medicare physician payment cuts, the Senate has not addressed the larger issue of replacing the Sustainable Growth Rate (SGR) formula, the flawed Medicare physician payment formula that results in the deep payment cuts that Congress must avert each year. 

The House also did not include a fix to the SGR in its large health reform package; however, it did pass a standalone bill on November 19, “Medicare Physician Payment Reform Act of 2009” (HR 3961), to overhaul the SGR. This bill provides approximately a 1.2 percent increase for 2010 based on the Medicare Economic Index (MEI) instead of a 21 percent Medicare physician payment cut.  Starting in 2011, the bill sets two separate targets for the growth rate of Medicare physician expenditures.  One target would cover all evaluation and management services and preventive services, and the second target would cover all other physician services.  Yearly updates would likely differ for the two categories.  Although it is unlikely that the Senate will consider this legislation before the end of the year, other vehicles are being discussed to address the payment cuts scheduled to take effect on January 1, 2010. The focus now is on passage this month of a payment patch lasting for weeks rather than months to address the immediate threat to physicians and patients. The details of this proposal and its legislative vehicle will be known in the next few days.