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Medicare Package Taking Shape in
Congress, HHS Secretary Makes Requests
Senate Finance Committee taking the lead
on Medicare reform
Dec. 4, 2007 -
HHS Secretary Mike Leavitt on Monday issued a statement
to Congress requesting that Medicare legislation not include
cuts to Medicare Advantage plans or changes to the Medicare
prescription drug benefit, CQ Today reports. Leavitt in the
statement said, "Both have proven to be highly popular with
the American people and worthy of continued support from
Congress."
A mark up of the Medicare package is
tentatively scheduled for Wednesday, but the
Senate Finance Committee might delay the mark up by at
least one day, according to a spokesperson for committee
ranking member Chuck Grassley (R-Iowa) (Armstrong, CQ Today,
12/3).
MA plan payments on average are 12%
higher than traditional Medicare. The Senate Medicare bill
is expected to reduce some additional payments to MA plans
to generate revenue, while the House measure would make MA
payments equal to traditional Medicare to generate $50
billion over five years.
The Bush administration last week
during a meeting with Senate Finance Committee staffers said
that it also opposes a provision of the Medicare legislation
that would give states more power to penalize private MA
plans that use questionable marketing tactics.
According to CongressDaily, "The White
House's protest came as a surprise to negotiators, who
inserted the new marketing language in response to reports
that private [MA] plans were using misleading marketing
tactics to get seniors to switch from traditional Medicare
by enrolling in the private fee-for-service plans." The
package, which could be released as early as Tuesday, would
curb a scheduled 10% cut to physician reimbursements. It
also is expected to have provisions that change the drug
benefit and create rural and low-income subsidies.
Health IT
Leavitt also said that "any new bill
should require physicians to implement health information
technology that meets department standards in order to be
eligible for higher payments from Medicare" (Johnson,
CongressDaily, 12/4).
Leavitt said Congress should require
physicians to adopt health IT that meets federal standards
before it stops a scheduled 10% cut in Medicare physician
fees. "Such a requirement would accelerate adoption of this
technology considerably and help to drive improvements in
health care quality as well as reductions in medical costs
and errors," according to Leavitt.
He added, "I'm confident that many
members of Congress are of a like mind of this issue, and I
will actively work with them in the near future" (CQ
HealthBeat, 12/3).
According to the
AP/Philadelphia Inquirer, health care analysts have said
widespread use of electronic health records will reduce
medical errors and could help reduce health care costs.
Currently, only 10% of small-group practices and solo
physicians use EHRs, the AP/Inquirer reports. The systems
can cost anywhere from $20,000 to $40,000 up front,
according to the AP/Inquirer (Freking, AP/Philadelphia
Inquirer, 12/3).
Sen. Edward Kennedy (D-Mass.) has
sponsored a health IT bill (S
1693) that he is trying to get passed before the end of
the session, but the Finance Committee has not discussed
health IT as part of the Medicare package, CQ
Today reports (CQ Today, 12/3).
E-Prescribing
Sens. John Kerry (D-Mass.) and Debbie
Stabenow (D-Mich.) plan to introduce stand-alone legislation
this week that would require handwritten prescriptions be
replaced by electronic prescriptions, but the senators are
working with Finance Committee Chair Max Baucus (D-Mont.)
and Grassley to add the requirement to the Medicare package,
aides said, CongressDaily reports.
The
American Medical Association is "wary of an
e-prescribing mandate," and its main priority is reversing
the 10% physician payment cut, according to CongressDaily.
The Finance Committee package would
include one-time payments for physicians to cover the
start-up costs and small incentive payments to continue
using the systems over three years. Switching to
e-prescribing would cost about $2,500 plus losses in
productivity during the transition, CongressDaily reports.
After three years, physicians would be penalized for not
using e-prescribing. Using the technology would save between
$5 billion and $15 billion over 10 years, according to some
estimates.
"Physicians are eager to adopt new
technologies that have the potential to increase patient
safety and quality of care, but hitting doctors with an
unfunded e-prescribing mandate at the same time the
government plans to cut Medicare physician payments 10% next
year is untenable," AMA Board Chair Edward Langston said
(Johnson [1], CongressDaily, 12/3).
Other Provisions
The Finance Committee has stalled
negotiations on a provision of the package that would extend
the length of time employers must cover kidney dialysis for
employees after a business coalition ran advertisements in a
Montana newspaper opposing increased responsibility for
employers, according to an aide familiar with the
negotiations, CongressDaily reports.
The ad ran in the Billings Gazette and
was paid for by the
Employers Coalition on Medicare. Under current law,
employees with group insurance must receive 30 months of
dialysis before Medicare coverage begins. The extension
would increase the requirement to 42 months, which would
save Medicare $1.2 billion over 10 years, according to the
Congressional Budget Office.
Employers say that the change would
cost them $3 billion to $4 billion over 10 years because
they do not have the purchasing power Medicare has. Baucus
was considering removing the requirement from the
legislation, but he might be "less inclined to sympathize"
with the coalition after the ads ran, according to
CongressDaily (Johnson [2], CongressDaily, 12/3).
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