Physician groups content, but not ecstatic on payment fix

After a year of fits and starts, Congress last week finally passed legislation to prevent a cut in Medicare’s payments to doctors, but the lawmakers leading the effort did so with scant last-minute help from the physicians’ lobby.

After a year of fits and starts, Congress last week finally passed legislation to prevent a cut in Medicare’s payments to doctors, but the lawmakers leading the effort did so with scant last-minute help from the physicians’ lobby.

House Ways and Means Committee staff reached out to a broad array of healthcare organizations Friday morning via e-mail, asking for their endorsement of the large tax and healthcare bill that eventually passed with overwhelming majorities in both chambers. Instead of a reduction, payments will be frozen at this year’s level.

Despite achieving a partial victory in the form of a $5.5 billion payment provision, physician groups gave the bill tepid support behind the scenes.


The roster of groups that gave their explicit support includes just four of the plethora of medical societies that lobbied Congress to block the 5 percent reduction to physician fees that would have hit on Jan. 1.

The American College of Cardiology, the American College of Physicians, the American Osteopathic Association and the College of American Pathologists are the only physician groups named among the 21 “organizations that support the health provisions in H. R. 6111,” according to a document published on the committee’s website yesterday. Big-business interests, nursing homes, laboratories and others make up the remainder of the list.

Other medical societies, including the American Medical Association (AMA), declined to issue the letters of support sought by the committee.

This fall, the AMA rejected an offer from Ways and Means Chairman Bill Thomas (R-Calif.) to fix next year’s payments in a way very similar to what passed in the tax and healthcare bill last week, a point Thomas emphasized during his farewell press conference Monday.

An AMA spokeswoman emphasized that the group made public statements on the bill before and after the House and Senate voted on it.


“We appreciate the bipartisan efforts by the House and Senate to prevent the 2007 Medicare cut triggered by the flawed Medicare physician payment system,” reads a written statement issued before the votes and attributed to Cecil Wilson, the chairman of the AMA’s board of trustees. After the bill passed, the AMA issued a similar statement from Wilson that also said, “Today’s action provides an important but temporary reprieve for seniors and the physicians who care for them.”

The AMA engaged in a full-throttle, year-long effort to get Congress to move against the 2007 payment cut and to enact a new formula to prevent cuts in future years, goals also sought by groups representing medical specialists.

The AMA also worked to dissuade lawmakers from establishing a system to link quality care to higher payments that the group argued would be premature.

The recently passed measure would offer a 1.5 percent payment bonus to doctors who report information about their practices, which would be a first step toward setting up a so-called pay-for-performance mechanism. The AMA also opposes a Bush administration pilot program to require quality reporting.

Some Democratic lawmakers poised to assume senior positions on healthcare committees next year, such as Rep. Pete Stark (Calif.), have rejected or expressed skepticism about pay-for-performance.

As part of its lobbying efforts the past two years, the AMA  aired television and radio advertisements in the home states and districts of key lawmakers, including some facing difficult reelection campaigns, which ruffled feathers on Capitol Hill. The AMA and other medical groups also bought ad time to promote their other major legislative priority, medical-liability reform; that bill failed to pass the Senate.

Congress has stepped in at the last minute for several consecutive years to prevent physician-payment cuts but has failed to enact a permanent fix to the formula.

The high cost of such legislation again proved an insurmountable hurdle this year. In addition, the desire of Thomas and other Republicans to enforce a pay-for-performance system provoked resistance from physician groups.

K Street and Capitol Hill sources also indicated that the relationship between Thomas and his staff and the lobbyists from the AMA had become more tense as talks wore on. In September, the AMA issued a statement thanking key lawmakers for their work on physician payments but left Thomas off the list.

Last year, the AMA agreed to support the payment fix at the 11th hour and to work with Congress on implementing a quality reporting and pay-for-performance system.

But signing on that letter with Thomas, House Energy and Commerce Committee Chairman Joe Barton (R-Texas) and House Energy and Commerce Committee Health Subcommittee Chairman Nathan Deal (R-Ga.) created some blowback for the AMA. Some other national and state medical societies resented the AMA for striking a deal without their participation .