Senate legislation to avoid Medicare cuts stalls

The U.S. Senate fell six votes short Thursday, June 12, of achieving the 60 votes needed to block debate on legislation that would have set aside an impending 10.6% cut in Medicare physician payments.

Fifty-four senators, primarily Democrats, voted in favor of cloture for the Medicare Improvement for Patient and Providers Act 2008 (S 3101). Thirty-nine senators opposed cloture on the bill, sponsored by Senator Finance Committee chair Max Baucus (D-MT).

The bill seeks to replace a physician payment cut of 10.6% scheduled by Medicare's Sustainable Growth Rate formula for July 1 with a 0.5% increase for the remainder of 2008. S 3101 also proposes to replace an additional 0.5% cut set to go into effect on Jan. 1, 2009 with a 1.1% raise.

The American Medical Association, American College of Radiology, and other physician advocacy organizations strongly support the bill.

Despite Wednesday's setback, bill supporters were still confident that Congress will find a remedy for the Medicare physician payment cuts, even with a presidential veto threat hanging on it and possible enactment of the cuts July 1.

The overall focus of the bill is to improve the Medicare program for its 44 million beneficiaries, particularly low-income seniors and those in rural areas, according to Baucus. Cosponsors are Sens. Jeff Bingaman (D-NM), John D. Rockefeller IV (D-WV), Gordon H. Smith (R-OR), and Olympia J. Snowe (R-ME).

"We all know what this vote was about, and it wasn't about what's best for American seniors," Baucus said. "The White House doesn't want overpaid private plans in Medicare to lose a single dime."

The vote was 54 to 39 in favor, but the bill needed 60 votes to enter the floor for discussion.

S 3101 includes several key provisions for imagers. Section 131 blocks pending cuts scheduled under the SGR formula, while increasing all Medicare Physician Fee Schedule rates for the next 18 months. Section 135 requires providers of advanced imaging services such as CT, MRI, and PET to be accredited by 2012. This section also establishes a two-year voluntary appropriateness criteria evaluation program.

To offset the reinstated cuts, the bill includes provisions that would phase out Medicare subsidies for indirect medical education and remove private Medicare Advantage plans. The Bush administration has threatened to veto the bill partly due to the latter provision. Sen. Charles Grassley (R-IA) had offered a separate bill similar to the Democratic version but without offsetting formulas.

"Congress can't operate on ideology," Baucus said. "We have to come to some fiscally responsible agreement on how to improve Medicare for low-income and rural beneficiaries, how to keep pharmacies up and running under the drug benefit, and how to keep doctors decently paid for seniors' care."

Though cautious, ACR officials hope a compromise bill could be sent to the Senate floor for discussion next week. Even if they cannot meet the deadline, both houses of Congress have assured physicians that they will continue to work to avert any further implementation of these cuts, said Joshua Cooper, ACR's senior director of government relations.

"We understand that the Centers for Medicare and Medicaid Services will have no choice but to start implementing the cuts, but Congress has made it clear that physicians would be reimbursed at a later date," Cooper said.

If negotiations fail, physicians could be forced to make some difficult decisions, including reduction in services and administrative or technical staff, which can hurt patients. Neither Congress nor radiologists want to see that happen, according to Cooper.

"I'm quite optimistic that Congress will pass something. Even if President Bush decides that he must veto whatever Congress sends in, I hope there's enough time to go back, negotiate, and get a bill back to (Bush) in time to avoid the June 30 deadline," he said.

The ACR is urging its membership to contact their congresspersons to support S 3101.

For more information from the Diagnostic Imaging archives:

IRs look for silver lining as government pushes quality

Universal coverage may mean practice changes

Congress may not find fix for impending Medicare physician rate cut

Congress delays reimbursement cuts