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Medicare News
Democrats Consider Eliminating Extra Pay to Medicare
Advantage Plans to Raise Physician Pay
Medicare Payment
Advisory Commission's report under fire on docs’ pay
March 7, 2007 - Democrats this year are making
"concerted efforts" to cut Medicare Advantage payment rates "as a way to
finance other spending priorities," such as fixing a scheduled 10%
reduction in Medicare physician payments,
CQ HealthBeat
reports (Carey,
CQ HealthBeat,
3/6).
House Energy and
Commerce Health Subcommittee Chair Frank Pallone (D-N.J.) on
Tuesday said he supports eliminating overpayments to Medicare Advantage
plans to prevent the physician payment reduction, which is scheduled to
take effect next year (Johnson,
Congress Daily
3/7).
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Senior Citizens in the Middle Again of Fight Between
Medicare Advantage Providers and Congress
Medicare Advantage fight a lot like Medicare+Choice debacle
 Feb. 28, 2007 – Senior citizens are once again
caught in the middle of a funding fight between insurance companies and
the federal government over the Medicare Advantage Program, which was
known as Medicare+Choice in the last battle in 2003. Today, there are
more than eight million seniors enrolled in this program that provides
more services at a lower cost than traditional Medicare, but are often
more limited in the health care providers available. Congress previously
approved $13 billion in cuts for these programs this year and the new
Congress is considering even more. The insurance companies are saying
this will lead to higher premiums for their senior customers.
Read
more...
Bush Budget Chops $101.5 Billion from Medicare,
Medicaid
Budget savings from higher premiums for some seniors,
revised regulations - Feb. 5, 2007
Read the latest news
on
Medicare
or
Medicare Drug Program |
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House Ways and Means
Health
Subcommittee Chair Pete Stark (D-Calif.) cited data from a
Medicare Payment
Advisory Commission
report
that indicated payment rates to Medicare Advantage plans average 112% of
fee-for-service payment rates (CQ
HealthBeat, 3/6).
Stark and Pallone both have said they want to find
a permanent solution for the Medicare physician payment system.
MedPAC Chair Glenn Hackbarth on Tuesday told the
House Ways and Means Health Subcommittee that a permanent solution to
the physician payment system could be funded in part by reimbursing
Medicare Advantage plans at the same rate as traditional fee-for-service
plans and by stopping inflation updates in payments to Medicare
providers.
MedPAC also has recommended that the federal
government develop payment incentives for physicians who provide quality
care and eliminate overpayments of certain services. Hackbarth said
overpayments could be addressed by
CMS at
a regulatory level, while other proposals, such as linking
reimbursements with quality care measures, would require congressional
action.
SCHIP
Stark also suggested that revenue generated by Medicare Advantage
payment cuts could be used to expand SCHIP (CongressDaily,
3/7). Separately,
Senate Finance
Committee Chair Max Baucus (D-Mont.) on Tuesday said Medicare
Advantage cuts could help fund an expansion of SCHIP (CQ
HealthBeat, 3/6). According to
CongressDaily,
eliminating overpayments to Medicare Advantage plans would generate $60
billion over 10 years, nearly enough to expand SCHIP coverage to all
eligible children -- which is estimated to cost $50 billion over five
years -- but not enough to also address physician payments (CongressDaily,
3/7).
Opposition
Rep. Jim McCrery (R-La.) on Tuesday in a letter to House colleagues
wrote that cutting Medicare Advantage payments could affect low-income
and minority beneficiaries. He said that Congress has "made that mistake
before," noting that when lawmakers reduced Medicare Advantage plan
payments in 1997, many plans dropped out of the program and more than
two million beneficiaries lost access and benefits (CQ
HealthBeat, 3/6).
Lawmakers Criticize MedPAC Report
Recommendations for Changes to Medicare Physician Payment System
Some House lawmakers on Tuesday "seemed
unimpressed" by the
Medicare Payment
Advisory Commission's report that was expected to make
recommendations for overhauling the current Medicare physician payment
formula,
CQ HealthBeat reports (Armstrong,
CQ HealthBeat,
3/6).
The MedPAC report, which was released last week,
includes two alternatives to the current system.
● One alternative would eliminate the
Sustainable Growth Rate formula that has been used for the past 10 years
to calculate physician reimbursements. The current SGR formula would
reduce Medicare physician reimbursements by 10% next year and by 40%
during the next eight years, according to the report. The report states
that the elimination of the SGR formula should be tied to new incentives
for physicians to provide better preventive care.
● A second alternative in the report would
distribute physician payments on a regional basis tied to cost
variations in medical services and reward physicians who provide more
efficient care. Although MedPAC is divided on whether Medicare should
continue to use a target level to calculate physician reimbursements,
the report said that any target level should apply to all health care
providers in Medicare, not only physicians (Kaiser
Daily Health Policy Report, 3/2).
At a House Energy and Commerce
Health
Subcommittee hearing on the report, lawmakers criticized the
commission for not making a clear recommendation. Rep. Anna Eshoo
(D-Calif.) said, "You haven't provided Congress any recommendations,"
adding, "There's hardly any meat on the bone. You've got to go back to
the drawing boards."
Rep. Diana DeGette (D-Colo.) said, "I think we
should disband this commission and get a new one, or send this (report)
back with instructions that they come up with a recommendation"
(Whitney,
San Luis Obispo
Tribune,
3/7).
House Ways and Means
Health
Subcommittee Chair Pete Stark (D-Calif.) said that members of
his panel were just as likely to be divided on the issue as MedPAC
members, adding, "I think we have to look at MedPAC as a good example of
what we face" (CQ
HealthBeat, 3/6). MedPAC Chair Glenn Hackbarth said, "The
complexity of the issues makes it difficult to recommend any option with
confidence" (San Luis Obispo
Tribune,
3/7).
Pallone Says SGR Formula Overhaul a Priority
Energy and Commerce Health Subcommittee Chair Frank Pallone (D-N.J.)
said that overhauling the SGR formula was a priority for the 110th
Congress.
"The goal is to try to do some kind of permanent
fix and not continue with these annual end-of-the-year changes," Pallone
said, adding, "We want to make an effort to do something, if possible,
this year, certainly within this session of Congress." Pallone also said
that Congress should examine MedPAC's recommendation to cut Medicare
Advantage reimbursements to secure more funding for physician payments (CQ
HealthBeat, 3/6).
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