Politics
CMS Proposes 6.1% Physican Payment Cut and Expanded Meidcare Services PDF  | Print |  Email

June 30, 2010

In a proposed rule by the Centers for Medicare and Medicaid Services (CMS) physicians could see a 6.1 percent Medicare payment cut on Jan. 1, 2011 and Medicare patients could see expanded services.

That cut could be much bigger if Congress does not take action on the current formula for Medicare payments to physicians. According to the sustainable growth rate formula (SGR) adopted in the Balanced Budget Act of 1997, Medicare physician payments should have been decreased every year since 2002. But every year legislation has stopped those increases.

On Jan. 25 President Obama signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. That Act averted a 21.3 percent cut in Medicare payments to doctors that was called for under the current SGR formula and was supposed to take effect on Jan. 1, 2010. That cut has been postponed three times and in the latest postponement by Congress doctors also gained a 2.2 percent increase in payments through Nov. 30, 2010.

But unless Congress passes new legislation, the SGR formula will call for that 21.3 percent cut on Dec. 1, 2010, plus the removal of the 2.2 percent payment increase for a total cut of 23.5 percent. Then on Jan. 1, 2011 the 6.1 percent cut could be added for a total cut of 29.6 percent. Although that 6.1 percent that is part of CMS’s proposed rule could very well be higher or lower by the time the rule is finalized, said Ellen Griffith, a CMS spokesperson.

“Unfortunately it pushes some doctors to the margins where they have no choice but to stop taking Medicare patients,” said Andrew LaMar, a spokesman for the California Medical Association. “If you can’t balance your books, pay your fees and staff, you have to take those kinds of steps,” he said.

With three postponements of Medicare payment cuts to doctors this year alone, there’s a lot of attention on the issue in Congress and CMA is thankful for the support its been getting on this issue from California members of Congress, LaMar said.

“Until there’s ultimately a repeal of SGR or something that provides more long-term stability, we’re going to have problems,” he said.

Griffith said the intent to make changes is clear. “The Obama Administration is committed to working with Congress to fix the formula,” she said.

CMS’s proposed rule also implements provisions in the Affordable Care Act of 2010 that would increase benefits to Medicare patients. To date Medicare has not paid for annual wellness visits, it has only paid for a “Welcome to Medicare Visit,” the initial preventative physical examination. This CMS proposed rule would eliminate out-of-pocket costs for wellness visits on an annual basis as well as for most other preventative services.

Some other elements of the proposed rule include a payment incentive program for general surgeons who do major surgeries in areas designated as Health Professional Shortage Areas.

The proposed rule would also decrease physicians’ payments for diagnostic imaging equipment used for computed tomography (CT) and magnetic resonance imaging (MRI) services. In order to compensate physicians for those machines CMS has to make assumptions as to how often they will be used.

“We had assumed this equipment would be used 50 percent of the time, data shows it’s used far more often,” Griffith said. “If you underestimate the use, you over pay for it,” she said. Congress modified the utilization rate to 75 percent which will reduce payments to physicians. That will in turn reduce payments Medicare patients have to make because their payments are based on a percentage of what CMS pays the doctors, Griffith said.

CMS will accept comments on the proposed rule until Aug. 24, 2010. It expects to issue a final rule, with responses to the comments around Nov. 1, 2010.


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Last Updated on Wednesday, 30 June 2010 15:50
 
Former UCSF Researcher to Lead NCI PDF  | Print |  Email
June 1, 2010

Harold Varmus, M.D., a former faculty member at the University of California, San Francisco for 20 years and a co-recipient of the 1989 Nobel Prize in Physiology or Medicine, has been chosen by President Barack Obama to become the Director of the National Cancer Institute (NCI).

Varmus is also a former Director of the National Institutes of Health, appointed by President Clinton in 1993. During his time there he coordinated the construction of a new clinical center, and helped to initiate the doubling of the NIH budget.

For the last decade Varmus has been President of Memorial Sloan-Kettering Cancer Center in New York City. He developed inter-institutional research programs there, led a two-billion capital campaign and initiated a graduate school in cancer biology.

At UCSF he researched cancer genes and retroviruses and it was his research on the genetic basis for cancer that won him the Nobel Prize along with J. Michael Bishop.

Francis Collins, M.D., Director of the NIH, said in an e-mail to NCI staff that Varmus, “brings unmatched expertise at all levels - not only in cutting edge scientific research, but also as a leader in the development of strategies for improving patient care, in scientific  education and training, and in the design of novel public-private partnerships.”

 


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Last Updated on Tuesday, 01 June 2010 14:35
 
FTC Delays June 1 Deadline for Red Flags Rule PDF  | Print |  Email

May 28, 2010

On Friday the U.S. Federal Trade Commission (FTC) again delayed enforcement of its Red Flags Rule at the request of several members of Congress. This gives the American Medical Association (AMA) more time to seek a permanent exemption for physicians.

The announcement comes after the AMA and two other medical organizations filed a federal lawsuit against the FTC on May 21 asking that the FTC be prevented from extending the rule to physicians. The rule requires certain businesses to implement procedures for preventing and detecting identity theft.

Then on Tues. May 25 Senators John Thune (R-S.D.) and Mark Begich (D-Alaska) introduced Senate Bill 3416 calling for exemption from the Red Flags Rule for some small businesses like doctors and dentists offices. Thune’s office reported that last year a similar bill, HR 3763, passed the House of Representatives with a unanimous vote, 400-0.

“Congress needs to fix the unintended consequences of the legislation establishing the Red Flags Rule – and to fix this problem quickly,” said FTC Chairman Jon Leibowitz in a press release. “We appreciate the efforts of Congressmen Barney Frank and John Adler for getting a clarifying measure passed in the House, and hope action in the Senate will be swift. As an agency we’re charged with enforcing the law, and endless extensions delay enforcement,” he said.

Congress directed the FTC and other agencies to create regulations requiring creditors and financial institutions to implement procedures for preventing and detecting identity theft. The FTC maintains that because physicians accept delayed payment through insurance reimbursement and payment plans, they are considered creditors. The rule became effective Jan. 1, 2008 and full compliance was originally scheduled for Nov. 1, 2008 but enforcement has been delayed several times.

“For two years the AMA has made the case to the FTC that physicians are not creditors like banks and lenders, and the misguided Red Flags Rule should not apply to them,” wrote Cecil B. Wilson, M.D., AMA President-elect, in a press release.

 


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Last Updated on Friday, 28 May 2010 11:52
 
State Budget Revision Stings Medi-Cal Patients/Hospitals PDF  | Print |  Email

May 18, 2010

Medi-Cal patients and the hospitals who serve them will be some of the hardest hit if Governor Arnold Schwarzenegger’s May revision to the state budget stands.

It calls for $750 million in savings from a Medi-Cal cost containment proposal. Some of those savings would come through increasing co-pays and premiums, establishing maximum annual benefit dollar caps on medical supplies, limiting the number of doctor visits to 10 per year and limiting the number of prescriptions, except for life-saving drugs, to six per month. Over-the-counter drugs and nutritional supplements would also no longer be paid for by Medi-Cal.

“The Governor’s revision is shifting costs to the county or low income residents who can’t afford the payments,” said Joy Alexiuo, the public information officer for the Santa Clara Valley Medical Center. A lot of the co-pays for Healthy Families and other programs are doubling, and although it may not seem like much, for those living on the poverty line it may mean the difference between going to the doctor and not.

“There will be low income children who won’t be able to get healthcare services because of premiums and co-pays,” Alexiou said. “We’ve worked really hard to cover every child in this county and this proposal takes us a huge step backward,” she said.

The Revised budget also calls for freezing hospital rates at the current level and to start charging a $50 co-payment on emergency room visits and a $100 daily copayment on hospital stays with a $200 maximum.  The California Hospital Association takes issue with these measures.

California hospitals lost $4.6 billion last year treating Medi-Cal patients, stated the California Hospital Association in a press release. “These individuals are already at the low end of the economic scale and do not have the financial resources to cover such unplanned expenses. As a result, hospitals will face greater losses when they treat Medi-Cal patients.”

The association states that California is close to the least-funded state in the nation in terms of funding Medicaid patients. 

Dan Robinson, Chief Administrative Officer of San Ramon-based Hill Physicians Medical Group, which represents 3,000 physicians, said that the Governor’s proposals might result in less willingness by some physicians to see Medi-Cal patients, but he doesn’t think it will impact a huge number of individuals.

Hill’s physicians serve Medi-Cal patients in Sacramento and Stockton and the company has recently entered the Medi-Cal market in San Francisco. Robinson says the company is expanding into Medi-Cal because the company believes it is the right thing to do. “We fully expect to continue to expand in San Francisco with our Medi-Cal [services]. The Governor’s budget does not change our resolve,” he said.

The governor released his May revision of the budget on May 14 and it is meant to address a $19.9 billion budget gap.

Other provisions affecting Medi-Cal recipients are the establishment of maximum annual benefits on items like hearing aids, which would be capped at $1,510, and durable medical equipment, which would be capped at $1,604.

 

 

 

 

 


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Last Updated on Tuesday, 18 May 2010 12:51
 
Bunning Drops Objections; Temporary Freeze on SGR Cuts Passes PDF  | Print |  Email

After considerable political pressure was applied from both parties, Kentucky Senator Jim Bunning dropped his objections to a bill (HR 4691) that will temporarily delay the 21% Medicare payment cuts that were scheduled to take place March 1st. With Bunning’s objections put aside, the Senate passed the bill 78-19 and it was signed by President Obama on Tuesday.

The bill also includes a 30-day extension of COBRA health care benefits for unemployed U.S. residents.

Next on the Senate’s agenda is consideration of HR 4213, which will provide a longer extension of the provisions of HR 4691. HR 4213 would extend these benefits for the rest of 2010, but may cost upwards of $150 billion overall.

Medicare contractors had been instructed to hold claims for 10 days, which means any services provided in the first quarter of 2010 will be reimbursed at the present rate.


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Last Updated on Thursday, 03 June 2010 13:44
 
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