Delay on Hospital Payment Proposal Expected
CMS likely will delay the implementation of a proposal that would make "sweeping" revisions to the Medicare impatient reimbursement system, Stephen Ubl, president and CEO of the Advanced Medical Technology Association, said on Monday, Dow Jones reports (Kamp, Dow Jones, 7/17).
CMS in April announced the proposal, which includes the closure of loopholes used by specialty hospitals and a plan to replace the current charge-based reimbursement system with a cost-based system. Under the proposal, the cost-based reimbursement system would take effect in October, and severity-adjusted reimbursements -- which would pay hospitals more for the treatment of sicker patients -- would take effect in October 2007.
The proposal would reduce reimbursements for angioplasties and subsequent implantation of drug-coated stents by 33% to $7,590 and reduce reimbursements for implantation of defibrillators by 23% to $22,000 (California Healthline, 7/17).
Ubl said he is "pretty confident" of "some form of delay to allow stakeholders to comment" on the proposal, adding, "How long that delay is is still up in the air." AdvaMed has requested a one-year delay.
According to Dow Jones, the medical device industry has concerns about "the age of hospital cost reports that would be relied upon" to determine reimbursements under the proposal because older reports might not "accurately reflect costs for newer technology like drug-coated stents."
About 240 lawmakers last week sent a letter to CMS Administrator Mark McClellan that requested a delay in the implementation of the proposal, and the Heart Rhythm Society and the American Hospital Association last month also requested a delay.
The support for a delay indicates that the medical device industry "has gotten some traction in its lobbying efforts," and analysts expect the final proposal "to take a softer approach," Dow Jones reports (Dow Jones, 7/17).
In related news, lawmakers likely will not introduce legislation that would prevent a scheduled reduction in Medicare physician reimbursements until after the November election, CongressDaily reports. Medicare physician reimbursements will decrease by almost 5% on Jan. 1, 2007, without congressional action.
According to analysts and lobbyists, lawmakers might attach legislation that would prevent the reduction to an "omnibus package of unfinished appropriations and other legislation, similar to 2003, when a one-year fix was included that provided a 1.6% increase," CongressDaily reports. A one-year freeze on Medicare physician reimbursements would cost $1.1 billion in fiscal year 2007 and $10.8 billion over five years, according to a Congressional Budget Office analysis.
The American Medical Association has called for a 2.8% increase in Medicare physician reimbursements.
House Energy and Commerce Committee Chair Joe Barton (R-Texas) said, "I think it'll be a lame-duck session issue." Barton and Senate Finance Committee Chair Chuck Grassley (R-Iowa) said that they hope to link increased Medicare physician reimbursements with structural changes in the program.
A Grassley aide said that the senator hopes to "link Medicare payments with provider performance" to ensure physicians receive higher Medicare reimbursements "for efficient, quality care." Barton said that he hopes to "come up with an alternative to the current, automatic relief program" (Cohn, CongressDaily, 7/17).