Senate Approves Two-Month Freeze of Medicare Fees

Posted in Medicare on December 17th, 2011 by MMS – Comments Off on Senate Approves Two-Month Freeze of Medicare Fees

By a lopsided 89-10 vote, the Senate approved a bill on Saturday morning that would freeze physicians’ Medicare fees at current levels for two months, temporarily averting a devastating 27% cut.

UPDATE: House Speaker John Boehner said Sunday that the House will probably reject this bill, and send it to conference committee for further negotiation. That would make a resolution of the matter before the New Year quite dim.

In addition to the Medicare provision, the bill extends a payroll tax holiday and extends long-term unemployment benefits for the same two-month period.

One big dispute, the construction of an oil pipeline between Canada and Texas, was resolved when Democrats dropped their opposition, in return for Republicans accepting the payroll tax and unemployment extensions.

The AMA responded with a renewed call for a permanent reform of the Medicare payment formula.

“It is time for Congress to act on previous commitments to repeal the failed Medicare physician payment formula,” said AMA President Peter Carmel, MD.

“The 12 temporary patches that Congress has applied have raised the cost of solving the problem by more than 500 percent over the last few years and eroded patients’ access to care. A permanent solution is the long overdue, fiscally responsible approach,” he said.

Read more about Medicare and the  SGR issue here.

Congress Now Focusing on a Short-Term SGR Patch

Posted in Medicare on December 16th, 2011 by MMS – Comments Off on Congress Now Focusing on a Short-Term SGR Patch

Congressional leaders are now negotiating a short-term reprieve from the looming 27% cut in Medicare payments, as an alternative to the two-year patch that was proposed by Republicans a week ago, according to news reports out of Washington.

The reprieve is expected to be for only two months. The shorter scenario would ensure that it would be fodder for the presidential campaign next year, in the middle of contentious primaries.

The bill would also include extensions of a middle-class payroll tax cut and long-term unemployment benefits. Debate now seems to be centered on the insistence of Republican leaders to include language speeding work on a Canada-to-Texas oil pipeline, which Democrats oppose.

It’s believed that the Senate will vote next week, and send it back to the House. Congress would then immediately go into recess for the holiday season.

Read more about Medicare and the  SGR issue here.

House Passes Two-Year SGR Fix, but the Senate Isn’t Buying It

Posted in Medicare on December 14th, 2011 by MMS – Comments Off on House Passes Two-Year SGR Fix, but the Senate Isn’t Buying It

Tuesday evening, the House passed legislation that, among other things, would block the 27 percent cut in physician Medicare fees for two years. The vote was 234-193. The entire Massachusetts delegation voted no.

The measure includes an extension of a payroll tax cut, extends unemployment benefits, and tries to force the President to make a decision on a controversial oil pipeline from Canada to Texas. Democrats seemed most upset about the pipeline provision, which they called a “poison pill.”

President Obama says he will veto the bill in its current form, and Senate leaders say they will write their own proposal on unemployment insurance, payroll taxes, and the SGR.

With Congress’ holiday recess looming, there isn’t much time to reach consensus. We’ll keep you posted.

GOP’s Proposed Two-Year SGR Patch Attracts Critics

Posted in Medicare on December 10th, 2011 by MMS – Comments Off on GOP’s Proposed Two-Year SGR Patch Attracts Critics

House Republicans on Friday proposed a two-year delay in Medicare payment cuts to physicians, pairing it with a one percent increase in payments for 2012 and 2013.

The AMA praised the two years of stability the package would ensure, but was critical of Congress’ failure to repeal the Medicare formula outright.

The two-year proposal is attracting stronger criticism from elsewhere in medicine, and from both political parties.

  • The American Hospital Association is unhappy that the proposal reduces hospital payments for outpatient evaluation and management services by $6.8 billion, and reduces reimbursements for Medicare bad debt.
  • The American College Radiology is happy that the bill doesn’t cut imaging services, but is disappointed that it left standing a 25 percent cut in professional fees for MRI, CT and ultrasound exams.
  • The Washington-based news service The Hill predicts rough sledding in the Democrat-controlled Senate. The $39 billion patch includes $25 billion in cuts to programs funded by the 2010 federal health reform law. If Democrats reject those cuts, more negotiations will be needed to find the money to pay for the patch.
  • The GOP proposal would also require high-income seniors to pay more for office visits and drug coverage. The AARP opposes means testing, but President Obama endorsed it in earlier deficit-cutting talks with Congress.
  • The proposal may be attacked by Republicans, too, because it adds $25 billion to the deficit over the next 10 years. Democrats are also unhappy with the Republicans’ approach to extending a payroll tax cut.

It’s expected the House will vote on December 13. House leaders say they hope to adjourn for the holidays by the end of next week.

What’s Next for the Medicare Payment Formula?

Posted in Medicare on November 23rd, 2011 by MMS – Comments Off on What’s Next for the Medicare Payment Formula?

The failure of the super committee’s negotiations this week shot an arrow through hopes that the Medicare physician payment formula would be repealed this year as part of the deficit reduction talks.

But is the 27 percent cut doomed to occur on January 1? The conventional wisdom in Washington says no.

Leaders of both parties said they want to block the cut. Congress returns to Washington after Thanksgiving for a short session to deal with several pieces of unfinished business, including the SGR.

So once again, the future of the SGR is in Congress’ hands. The consensus is that it will enact another short term patch, lasting perhaps another year or two. To get this done, leaders will have to find spending cuts to offset cost of the patch. The longer the patch, the more it will cost, and the more difficult it will be to find money to cut.

You’ve seen this before. Congress’ failure to deal with the payment formula has made the solution progressively more expensive. The AMA says the cost of the patch has risen 525 percent in the last five years, and will double again in the next five years.

In our view, the deficit reduction talks were the ideal opportunity to enact meaningful Medicare reform – and not just because of the benefits to patients and physicians. Putting Medicare on a sustainable model would have been in perfect harmony with the desire to reform the nation’s long-term financial health. If Medicare is broken, our nation’s finances are at risk.

We again thank Sen. John Kerry, a member of the super committee, for his continued strong support of Medicare payment reform. We hope the issue will be addressed again next year. But with the presidential campaign in full swing and the election just 50 weeks away, who knows?

The MMS website has lots more on Medicare, including a review of the options available to Massachusetts physicians as they consider their participation in Medicare for 2012. The deadline for making a change is December 31.

Act Now to Avoid the Medicare ePrescribing Penalty

Posted in e-prescribing, Medicare on October 28th, 2011 by MMS – Comments Off on Act Now to Avoid the Medicare ePrescribing Penalty

UPDATED:  Nov. 1, 2011

Physicians have until Tuesday, Nov. 8, to ask for an exemption from a 1 percent cut in Medicare payments for failing to meet Medicare’s ePrescribing requirements for 2012.

To get an extension, you must apply online. No other form of request will be accepted. To request an exemption, submit this online form.

Who’s eligible for an exemption?

  • You’re already registered in a Medicare or Medicare electronic health record incentive program
  • You prescribe infrequently. Either you wrote fewer than 10 prescriptions during the first six months of 2011, or had fewer than 100 Part B claims with codes and services that fall within ePrescribing measures during the first six months of 2011.
  • You practice in an area without high-speed internet access.
  • You practice in an area without enough pharmacies that can handle ePrescribing.
  • You cannot participate in the ePrescribing program because of limitations of local, state or federal law or regulation.

The physician must personally submit the application for an exemption – it cannot be done by someone else on your behalf.

If you’re not sure whether you qualify for an exemption, the AMA suggests that you apply anyway. There is no appeals process after the fact.

For more detailed information, download the AMA’s information sheet. (.pdf, 3 pages)

Apply for the exemption here.

What to Do if You Have Problems Accessing the Hardship Exemption Web Page

CMS and the QualityNet Help Desk has been receiving calls from Eligible Professionals who are having difficulty with accessing the Communication Support Page.  After doing some research they found that the problem is related to an issue with the internet browser.  CMS is asking eligible professionals to take the step below if they are unsuccessful in accessing the Communication Support Page when trying to submit their Hardship Exemption Request.

After typing in the above link, in the internet browser, select Tools/Internet Options/Advanced.  Scroll down toward the bottom and locate the “Use TLS 1.0” choice.  Place a checkmark in the “Use TLS 1.0.”  Click OK. Attempt to access the site again.

If you still have trouble accessing the site, the QualityNet Help Desk may be reached at 1-866-288-8912 or email at from 7am to 7pm CT, Monday through Friday.  Due to the high volume of calls that the QualityNet Help Desk has been receiving there may be a waiting period.

Report Highlights Risks to Mass. from “Super Committee”

Posted in Health Policy, Medicare on September 16th, 2011 by MMS – Comments Off on Report Highlights Risks to Mass. from “Super Committee”

Rep. Edward Markey has issued a detailed white paper on what’s at stake for Massachusetts when the debt ceiling “super committee” gets to work next month. It’s not a pretty picture for health care.

Medicare and Medicaid

These programs constitute 23 percent of federal spending, making them tempting targets for cuts. There have been proposals to raise Medicare’s eligibility age to 67, which would shift more health costs to seniors, employers and state governments.

Medicaid spending could also be cut. Under one proposal, states would be given lump sums to spend on Medicaid any way they choose, reducing federal outlays. These “block grants” would almost certainly mean cuts in state funding, too.

Medicare Physician Payment Formula

Physicians already face an enormous 29.5% payment cut on Jan. 1, 2012. The price tag to fix the formula is about $300 billion. It’s anyone’s guess as to how this will affect the super committee’s discussion on Medicare spending.  The American Medical Association believes that this is the best time to permanently solve the payment formula problem, but its cost makes this a challenging item, especially considering that the committee will struggle to come up $1.2 trillion in cuts overall.

Graduate Medical Education

Cutting federal funds for physician training was targeted during Congress’ summer session, but it didn’t happen. The super committee could revisit the issue this fall, and it would also be affected if across-the-board cuts take effect in calendar year 2013. The Simpson-Bowles Deficit reduction Commission recommended a 60 percent cut in this program. Under that proposal, Massachusetts would lose $312 million and more than 5,000 jobs.

Research Funding

The National Institutes of Health funded $2.5 billion in research in Massachusetts alone in fiscal 2010, supporting 35,000 jobs. Half of this goes to teaching hospitals. Massachusetts ranks second in NIH funding nationwide, even though by population we’re only the 15th largest state.

The Defense Department also funded about $35 million in health care research in Massachusetts during fiscal 2010, most of it going to teaching hospitals. Example: a program at the Dana-Farber Cancer Institute to understand how breast cancer metastasizes in the body.

The Effect

The report concluded, “While this source of funding has been beneficial to the Bay State, it also means we are especially vulnerable to drastic reductions in federal spending. … Perhaps the great underlying concern is that the debt deal’s spending cuts will undermine job growth.”

The Debt Deal: A Triple Whammy for Health Care?

Posted in Health Reform, Medicare on August 2nd, 2011 by MMS – 1 Comment

By Lynda Young, MD
President, Massachusetts Medical Society

After weeks of wrangling, the U.S. House and Senate have passed a plan to deal with the nation’s debt, and the President has signed it.  Through it all, Medicare beneficiaries have been protected, and that is a good thing.

No one, however, yet knows exactly how this will affect health care, because nothing has been decided, nothing has become law.  But the deal on the debt could be considered just one act of three that could have severe and widespread ramifications on patent care and physician practices.

Under the debt deal, a congressional committee is charged with developing proposals to come up with $1.2 trillion in cuts to federal spending over the next ten years.  If this joint panel can’t come up with enough in savings, automatic cuts go into effect. And that could mean a 2 percent cut in Medicare payments to providers.

At the same time, physicians are still facing a 30 percent cut in Medicare reimbursements, courtesy of the prevailing SGR formula – an annual albatross that physicians for years have been trying to correct.

On top of that, the Independent Payment Advisory Board, created by the Affordable Care Act and charged with reducing the growth rate in Medicare, calls for $14 billion in cuts in 2015, with physicians,   insurers, and pharmaceutical companies taking the hit.

All of this is happening at a time when the nation struggles with physician shortages, particularly in primary care, and when Medicare ranks are being swelled daily with the arrival of the baby boom generation – about 10,000 a day by some estimates.

There is no question that the depths of these cuts will severely impact access to care for patients and the ability of physicians to care for their patients.  Just how much remains to be seen.

The good news is that physicians’ voices are being heard. MMS is working with the AMA and congressional leaders to do what it can to ensure patients get access to care and that physician practices remain viable.  Be assured MMS will keep its members informed of these issues.

Dr. Lynda Young is a pediatrician based in Worcester, Mass.

In the Debt Compromise, What Happens to Medicare?

Posted in Medicare on August 1st, 2011 by MMS – Comments Off on In the Debt Compromise, What Happens to Medicare?

The debt ceiling compromise that Congress is debating today spares Medicaid from budget cuts, but could cut Medicare later this year.

Medicare cannot be touched in the initial cuts of $1 trillion that would take effect immediately if Congress votes today or tomorrow. But it is vulnerable to reductions when a new Joint Select Committee of Deficit Reduction meets later this year to find an additional $1.5 trillion in cuts. Congress must approve those recommendations with an up-or-down vote.

The pending 30% cut in Medicare reimbursements to physicians is not addressed by the agreement. But the Joint Select Committee is permitted to address the SGR formula, tax increases and tax loopholes in its deliberations.

If that committee fails to recommend savings, or if Congress fails to vote by December 23, then the debt ceiling is automatically raised by $1.2 trillion and across-the-board cuts equal to $1.2 trillion must be made. Half would come from defense spending, the other half from non-defense spending. Medicaid would be exempted from those cuts, but Medicare could be reduced by up to 2% of current spending, and all of it would come out of provider fees. Again, this would only happen if the Joint Select Committee fails to do its job.

Of course, all of the above assumes that the compromise hammered out last night passes as written.

Stay tuned!

Amid Debt Talks, The Push for SGR Reform Continues

Posted in Medicare on July 25th, 2011 by MMS – Comments Off on Amid Debt Talks, The Push for SGR Reform Continues

The good news for medicine last week during the debt ceiling talks was that reforming the Medicare payment formula was a serious part of the discussion.

The bad news today is that there’s no deal yet, and the cost of true SGR reform may be prohibitive.

In this context, the AMA and several other national groups circulated this video, which makes a compelling argument about the need for SGR reform.

The argument is further expanded in a recent letter to the president, vice president and congressional leaders. It was co-signed by the AMA, MMS, and 111 other state and medical specialty societies.

Please share this video with anyone for whom you think it would be helpful.

Stay updated on the Medicare debate on the MMS website and blog.