Doctors hold out hope to fix payment cuts in lameduck

Last week’s election results further complicated what already was a difficult haul for the physician lobby: getting action during the lame-duck session on a cut in their payments from Medicare that will kick in at the beginning of 2007.

Last week’s election results further complicated what already was a difficult haul for the physician lobby: getting action during the lame-duck session on a cut in their payments from Medicare that will kick in at the beginning of 2007.

Lobbyists representing doctors had counted on picking up where they left off in their negotiations with Republican lawmakers in hopes of pulling off another 11th-hour deal in what has become an annual struggle.

But if those talks do not lead to even a temporary delay of the more than five percent cut that will begin Jan. 1, physician lobbyists will have to contend with uncertainty about how the new Democratic majority will deal with what doctors view as an urgent problem.

Unless the outgoing Republicans can use the lame-duck session to find the solution that eluded them all year, the American Medical Association (AMA) will have to look instead to Democrats next year after having directed 73 percent of its campaign giving to Republican candidates.

The AMA worked closely with Democrats in the past on issues such as the “patients’ bill of rights,” but has been at odds with the party over the issue of medical malpractice tort reform.

The group also ran afoul of some Republican lawmakers this year by running advertisements about the payment cut in districts or states represented by Republicans seeking reelection.

The statutory formula that sets Medicare payments to physicians, which is widely considered to be faulty, has called for cuts for several consecutive years, but Congress stepped in each time to prevent them.

In the aftermath of the Republican defeat, as the House GOP is focused more on this week’s leadership elections than on complex policy matters, physician lobbyists are nervous that the lame duck will come and go without the payments issue being addressed.

The AMA and other groups, such as those representing specialist physicians, continue to push for last-minute actions and are staging meetings with Republican staff this week, even as GOP members themselves are preoccupied with preparing for life in the minority.

Moreover, if the GOP leadership in either chamber decides to bring a rapid close to the lame-duck session and declines to move the pending appropriations measures in favor of a continuing resolution lasting until next year, the physicians will lose their most likely vehicle for a payment fix.

House Republicans are circulating a proposal that would postpone the cut for only a few months, thereby leaving the Democrats with the responsibility for finding offsets to finance a longer-term solution.

But the AMA continues to demand more than a delay or another year of payments frozen at this year’s level. In a report prepared for its board of trustees meeting this week, the AMA reiterates that it wants physicians’ payments to be increased.

Rep. Nancy Johnson (R-Conn.) is considered to be the most active House Republican on doctor-payment reforms. Johnson’s unsuccessful reelection bid was backed by more than $300,000 the AMA spent on media and polling to help her hold the seat, the Washington Post and other sources have reported.

Lobbyists described retiring House Ways and Means Committee Chairman Bill Thomas (R-Calif.) as disengaged from the issue, after having taken a leading role in negotiating with doctors over a short- and long-term fix to their payments problem.

Before the election, the physician lobby turned down Thomas’s offer of a bill that would have paid for holding off the cut by increasing the reductions in future years.

Republicans also have pressed the AMA and its allies to accept a deal under which they would agree to a new system that linked their payments to improving the quality of the care they provide. Physicians have embraced the concept but have expressed deep concern about how “quality” would be measured. Democrats are generally less committed to implementing “pay-for-performance” systems in Medicare.

To bolster its efforts, the AMA says that more than 3,000 doctors are coming to the capital this week and are being dispatched to lawmakers’ offices on behalf of the AMA and its allies. Their central message: Lower payments could force physicians to treat fewer Medicare patients.

According to a partial schedule for those meetings obtained by The Hill, physicians and lobbyists will meet with aides to Republican and Democratic lawmakers in both chambers, including representatives of Rep. John Dingell (D-Mich.), the presumptive incoming chairman of the Energy and Commerce Committee, and Rep. Pete Stark (D-Calif.), who is in line to chair the Ways and Means Committee’s Health Subcommittee.

Dingell and Stark each introduced legislation during the 109th Congress that would have provided doctors with a  payment increase  for next year.

Stark has a long — and sometimes rocky — history with the physician lobby that dates back to his previous tenure in the majority. He is regarded as less sympathetic to doctors’ complaints about payments and more interested in taking on other Medicare issues, such as premium rates or the cost of drugs under Part D.

Congressional Democrats say they plan to tackle Medicare at the start of the 110th Congress by drafting legislation to permit the federal government to negotiate drug prices with manufacturers.

In addition, Democratic committee leaders are expected to work on a larger Medicare package later in the year. Among their stated priorities is reducing payments to health-insurance companies, but the package also could be used as a vehicle for the physician payments and other issues.