Doctors protest Medicare fee cuts

Members and aides will glimpse a familiar sight this morning on the Capitol’s West Lawn: angry physicians, wearing lab coats and toting picket signs.

With just days left before lawmakers leave town to campaign, lobbying groups representing doctors are continuing their frantic push to get the key players in Congress to set aside their differences and quickly move legislation to prevent a 5.1 percent cut in Medicare fees for doctors that will kick in on Jan. 1.

The American Academy of Family Physicians (AAFP) organized today’s event, which is billed as a rally. The group says that 2,000 family doctors representing every state will be there, joined by Sen. Jon Kyl (R-Ariz.) and Rep. Pete Stark (D-Calif.).

“I think it’ll show them that we’re kind of mad,” AAFP President Larry Fields said in an interview last week.

Lawmakers aren’t likely to need the reminder.

Chronic flaws in Medicare complicated payment formula have compelled Congress to enact one- or two-year fixes for consecutive years. Like this year, Congress has taken action at the 11th-hour, once even passing a retroactive payment adjustment after the New Year.

Physician groups such as the American Medical Association (AMA) and the AAFP have been especially aggressive this year in communicating their frustration to Congress.

The AMA targeted an advertising campaign in the districts of lawmakers on important committees. Some of those ads ran in the districts of vulnerable Republican incumbents, which has generated some backlash for the AMA on the Hill.

Physician lobbyists maintain that their needs are urgent enough to justify their forcefulness. Although lawmakers accept that Medicare’s payment system is faulty, Fields said, they do not appreciate the ramifications of inaction.

Doctors perennially predict that lower Medicare payments will cause many of them to choose not to treat beneficiaries. The AAFP also says that a nationwide shortage of primary-care physicians is worsening.

“They don’t see a crisis in access for the Medicare population,” Fields said. “I hope they don’t force some sort of crisis,” he added.

But Congress is taking the problem seriously and the staffs and members of the three committees of jurisdiction have been rushing to concoct a way of adjusting next year’s payments while keeping the budget score manageable and planting the seeds of a payment system that offers financial rewards for better medical care.

The hardest work will come in the days ahead. Competing proposals are emerging from House Energy and Commerce Committee Chairman Joe Barton (R-Texas) and Health Subcommittee Chairman Nathan Deal (R-Ga.); Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking member Max Baucus (D-Mont.); and House Ways and Means Committee Health Subcommittee Chairwoman Nancy Johnson (R-Conn.).

Ways and Means Committee Chairman Bill Thomas (R-Calif.) has been maintaining a characteristically low profile in recent weeks since the AMA reportedly rejected his proposed legislation, but is said to be quietly crafting new legislation.

Tomorrow afternoon, Deal’s subcommittee will hold a hearing on Medicare’s physician-payment system. A full committee spokesman cautioned, however, that its work could be far from finished.

“We hope to have a legislative solution soon, but crafting a good one might take more time than we have this week,” he wrote in an e-mail.

Last week, the AMA issued a statement praising Barton, Johnson, Grassley and Baucus for advancing proposals and urging them to come together on a consensus package. The press release conspicuously did not mention Thomas, who is retiring from Congress at the end of the session.

The closest any legislation has come to consideration on the floor of either chamber came last Thursday when Sen. Debbie Stabenow (D-Mich.) attempted to pass a one-year fix via a unanimous consent request. Sen. Larry Craig (R-Idaho) objected and blocked the bill, arguing that it would be better to return to the issue after Election Day.

Any physician-payments bill could attract other action on Medicare, such as eliminating the financial penalty that will hit beneficiaries who failed to sign up for the Part D prescription-drug this year. Enrollment for next year begins eight days after the midterm elections.

Medicare legislation also could be accompanied by a handful of other provisions, such as the extension of payment bonuses for rural hospitals; the relaxation of caps on physical, occupational and speech therapy;

If these lawmakers and the leadership in both chambers were able to come to agreement — or outflank one another — on the substance of the physician-payment language, they would have to choose from a limited number of vehicles.

The pending appropriations bill for the Department of Health and Human Services or an omnibus appropriations measure is regarded as a suitable vehicle but will not get congressional attention until after the election. Some physician lobbyists argue that moving a Medicare bill after the election would be even more difficult that beforehand and are urging Congress to act this month.

Pending legislation to promote the use of health-information technology has also been identified as a possible vehicle for the Medicare language. The Ways and Means, Energy and Commerce, and Senate Health, Education, Labor and Pensions committees are engaged in talks on the bill, which is a favorite of Senate Majority Leader Bill Frist (R-Tenn.) and has been designated part of the House GOP’s pre-election “suburban agenda.”

In conjunction with the AAFP event today, the group also released a survey that it says illustrates the public’s support for broad healthcare reform. The Republican polling firm Public Opinion Strategies and the Democratic firm Lake Research Partners jointly conducted the survey earlier this month.

According to the poll, 32 percent of people think that the healthcare system is not serving them well. “People are starting to feel more personally vulnerable,” said Fields. In addition, 68 percent perceive that the healthcare system is not working for other people.

On Monday, a federal advisory panel called the Citizen’s Health Care Working Group issued its congressionally mandated findings on the public’s views on healthcare reform. According to the report, Congress should strive to establish universal healthcare coverage by 2012. Under statute, President Bush has 45 days to respond to the report, after which Congress must hold hearings.