Congress again delays action on Medicare reimbursement formula

July 1, 2010

A six-month plan to forestall Medicare reimbursement cuts yet again - a proposal pending in the Senate at press time - is the latest in a series of delays that continues to leave dermatologists and other physicians frustrated.

Key Points

National report - A six-month plan to forestall Medicare reimbursement cuts yet again - a proposal pending in the Senate at press time - is the latest in a series of delays that continues to leave dermatologists and other physicians frustrated.

Senate Democrats planned to offer the proposal, which would cost an estimated $6.5 billion, in mid-June after failing to invoke cloture on a bill that included a 19-month patch for Medicare's sustainable growth rate (SGR) formula.

Neither measure would rework the formula, which was poised to mandate a 21 percent reimbursement cut beginning June 18. The new measure would reverse that reduction and provide a 2.2 percent increase through Nov. 30.

In early June, the Senate was considering amendments to the American Jobs and Closing Tax Loopholes Act of 2010 (HR 4213), including a 19-month fix for the SGR, says Regan Lachapelle, deputy communications director for U.S. Senate majority leader Harry Reid (D-Nev.).

Passed by the House on March 28, the bill's amendments include a 2.2 percent raise in reimbursements for physicians through the end of 2010, then another 1 percent increase in 2011, according to a Senate summary. Under that proposal, rates would return to current levels after 2011.

The provision would cost an estimated $22.9 billion over 10 years, according to the summary.

On June 14, Sen. Reid filed a motion to invoke cloture on HR 4213, Ms. Lachapelle says. This would have limited discussion on the measure to 30 hours, provided at least 60 senators supported the cloture motion. However, the motion failed, according to congressional records, leaving the SGR fix hanging.

At press time, the latest hold that the Centers for Medicare & Medicaid Services (CMS) had placed on physician payments in anticipation of an SGR solution was scheduled to expire on June 17. Barring any additional action by CMS or Congress, an SGR-mandated 21 percent physician reimbursement pay cut was to begin on June 18.

Dermatologists express frustration with Congress's latest failure to repair the SGR.

"The Senate has reached a level of dysfunction that has made it increasingly difficult even to legislate short-term fixes to the SGR, putting access to healthcare at risk for our nation's seniors and military families, and making it impossible for physicians ... to invest in their employees and their practices.

"No single political party is to blame - this is a bipartisan problem in the Senate," says Jack A. Resneck, M.D. He is associate professor of dermatology and health policy, dermatology residency program director and dermatology faculty practice director at the University of California, San Francisco, School of Medicine, and chairman of the American Academy of Dermatology Association (AADA) Council on Government Affairs, Health Policy and Practice.