Bill To Change Medicare Payment Formula for Doctors Clears House
On Thursday, the House voted 243-183, with one Republican joining 242 Democrats, to approve a $210 billion bill (HR 3961) that would avert a scheduled 21% reduction in Medicare reimbursements to physicians and permanently change the payment formula that results in annual proposed cuts to doctors' reimbursements, the New York Times' "Prescriptions" reports (Herszenhorn, "Prescriptions," New York Times, 11/19).
The new payment formula under the bill would set spending increases at the growth rate of gross domestic product plus 1%.
The legislation also would emphasize primary and preventive care by increasing reimbursements for those areas at the GDP growth rate plus 2%, which supporters of the bill say would lead to reduced long-term spending by promoting early disease detection (American Health Line, 11/19).
The bill also would restructure the current payment formula -- called the sustainable growth rate -- on a long-term basis beginning in either 2011 or 2014 and based on spending since 2009. Two separate updates would be provided, one for evaluation, management and preventive services and a second update for other services.
The current SGR formula, approved in 1997, originally was intended to lower costs by annually resetting physician payment rates, but Congress has repeatedly passed bills offsetting the reductions to Medicare reimbursements. The most recent temporary fix came in 2008 (Armstrong/McCarthy, CQ Today, 11/19).
Republicans said they opposed the measure because the bill's cost would not be offset.
House Democrats originally hoped to include the change in reimbursement method in the broader health reform bill, but the fix's cost proved too large to be accommodated in that legislation ("Prescriptions," New York Times, 11/19).
Legislation Faces Uncertain Prospects in Senate
The Senate rejected similar legislation (S 1776) in October in a 47-53 procedural vote (CQ Today, 11/19).
Twelve Democrats and one independent joined Republicans in opposing the bill because its costs were not offset ("Prescriptions," New York Times, 11/19).Senate Majority Leader Harry Reid (D-Nev.) has said he will reintroduce the bill once the Senate completes work on health reform legislation (CQ Today, 11/19). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.