Hospitals Lobby Congress on Doc Fix
Hospital groups were on the Hill this week lobbying members to protect their current level of Medicare reimbursements. A recent proposal from the Medicare Payment Advisory Commission (“MedPAC”), which advises Congress on Medicare payment policy, would lower the hospital payments to the amount a physician would receive in his or her own private office.
According to the hospitals, the MedPAC proposal would cut hospital reimbursements by 68% to 80%. With Congress looking for savings to pay for the 2013 physician reimbursements, any MedPAC proposal offering cost savings will be heavily weighed.
Consumer Survey Results Reveal Warning Signs for Hospitals
A post-election survey conducted by PricewaterhouseCoopers Health Research Institute contains warning signs for segments of the health industry. Over half the voters surveyed said they want budget savings to come from lower payments to doctors and hospitals. Health information technology was the second choice for reductions, despite a ramp up in efforts by the federal government to digitally connect doctors and hospitals to patients. Nearly seven of ten voters indicated they want the Administration to rein in high health care costs over the next four years.
House Committee Examines Medicare Fraud
On November 28, the House Energy and Commerce Subcommittee on Health held a hearing to examine options to combat waste, fraud and abuse in health care. While there was bipartisan agreement that reducing fraud could offer billions in savings, members differed on how the savings could be accomplished.
Republican members criticized CMS for not taking a more active approach in reducing fraud, citing $60 billion that Medicare annually loses to waste, fraud and abuse. The hearing witnesses included testimony from the Government Accountability Office that noted CMS has made progress, thanks in part to new fraud prevention programs stemming from the 2010 health care law (PL 111-148, PL 111-152).
Committee members and several witnesses spoke in support of smart card legislation, saying the program would decrease fraudulent transactions. H.R. 2925, a bill that would institute a pilot program in five states to give Medicare beneficiaries and providers “smart” identification cards, was debated at length. Under the program, providers would swipe the cards, with their individual identification numbers encrypted on a chip, before providing services.
Physician Sunshine Final Rule Arrives at OMB
The anticipated final rule governing how device and drug companies report payments made to doctors was submitted to the Office of Management and Budget (“OMB”), the final stop before publication. The sunshine provision stems from the Affordable Care Act and was developed in the Senate after a series of disclosures about financial relationships between pharmaceutical companies and physicians. The intent behind the rule is limiting the influence of drug maker marketing.
The description of the rule says it will require manufacturers of drugs, devices, biologics or medical supplies covered by Medicare or Medicaid to annually report to HHS on certain payments to physicians or teaching hospitals. Rules can be held at OMB for review for months, weeks or, in some instances, only days.
Legislation Introduced in Congress
H.R. 6598: Rep. Black (R-TN) introduced legislation intended to improve the HI-TECH Act of 2009 by amending penalties that harm eligible professionals and encourage the adoption of electronic health records (“EHRs”). The bill creates a “hardship exemption” for small practices and physicians in and near retirement to avoid workforce shortage. The legislation also intends to expand options for participation in the EHR incentive program among rural health care providers. Finally, the bill would establish an appeals process for providers before CMS could impose penalties for not meeting EHR requirements.
Next Week in Congress
The White House and Congressional leadership will continue to negotiate the impending year-end fiscal cliff. With little progress made in the week following Thanksgiving, the odds of at least temporarily going over the cliff become more likely. Congress returns next week and will continue work on updating the sustainable growth rate formula, which reimburses doctors treating Medicare patients. Were Congress not to act, physicians will face substantial cuts in 2013. There are just 32 days remaining in 2012.
For more information, please contact John F. Williams, III at 317.977.1462 or jwilliams@hallrender.com.
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