American Academy of Family Practitioners Calls on Congress To Stop Harming Patients By Failing To Pass Payment Fix

The American Academy of Family Practitioners has called on Congress to stop harming patients and do their job. The text of their statement follows:

“The House and Senate are pulling the rug out from under millions of Americans who depend on Medicare and TRICARE for their health care coverage.

“This squabbling is intolerable. Political infighting over the Medicare physician payment fiasco has gone on far too long. It threatens access to care for elderly and disabled patients and for members of our armed services and their families. It seriously undermines physician confidence that Medicare will reliably pay for the services already rendered. It undercuts the foundation on which health care reform is to be built.

“For many rural and underserved communities, family physicians are the only health care professionals. They have operated on razor thin margins since Medicare payment stagnated nine years ago. The 21 percent pay cut that went into effect June 1 has pushed their Medicare compensation to levels they haven’t seen since 1994. Now these physicians — often the only source of health care in rural and underserved areas — face the possibility of cutting their staff, missing payroll, and limiting the number of Medicare and TRICARE patients they can accept.

“Congress must stop harming patients and act on legislation that retroactively restores the 21 percent Medicare payment cut with a formula that provides stability to the system. They must stop playing with the lives of constituents with the one-upmanship and political scorekeeping. They must pass legislation that ends these outrageous political games that puts the health and welfare of millions of Americans at risk.”

American College of Physicians Blasts Congress For Causing “Irreparable damage to Medicare”

The American College of Physicians has released the following statement protesting the failure of Congress to continue Medicare payments on schedule in June, blasting Congress for causing “Irreparable damage to Medicare” as seniors and military families face loss of access to health care:

Today,  the  Senate  and  House  remain  at loggerheads on  how to reverse  a devastating  cut  in Medicare and TRICARE payments to physicians.

Today, Medicare  claims are being processed, retroactive  to June 1, with a 21 percent  cut, which is not enough to even begin to cover the costs of delivering care.

Today, tens of thousands of  physician  practices are facing the real possibility that they will have to lay‐off staff, miss payroll, limit how many Medicare and military families they can accept, or even close their doors.

Today, millions of America’s seniors and military families are finding that Medicare no longer is a reliable or stable partner.

And  each  and every day  that the cut remains in effect, more and more seniors and military families will find that they can’t get an appointment with a doctor.

Each and every day  the cut remains in effect, physicians will continue to lose confidence in the ability of Congress, the President, and  both political parties to do the right thing by patients.

This loss of trust in government not only harms Medicare and TRICARE, but threatens to undermine physicians’ confidence in the federal government’s ability to manage health care reform effectively.

It  is past time  for politicians from both political parties and both chambers to stop blaming someone else for the impasse. Physicians and patients don’t want to hear that it is the Democrats’ fault, or the Republicans’, or the President’s, or the Senate’s, or the House’s. They don’t want to hear politicians claim that they are for repealing the SGR, as they withhold their vote from any practical plan to achieve repeal.

They want to hear that the people they elected can work together to solve the problem.

They want to hear that the House and Senate have resolved their differences and enacted legislation to immediately reverse the 21 percent cut and make physicians whole for the damage already done.

They want to hear that  members of Congress, on a bicameral and bipartisan  basis, have agreed on a long‐term solution to replace the unworkable SGR. Such a solution, at a minimum, would provide stable, reliable and positive payments or all services that cover physicians’ costs, provides for higher updates for primary care visits and preventive services, and lead to repeal of the SGR.

Absent such agreement, physicians and their patients will continue  to lose faith  in Medicare and TRICARE, causing potentially irreparable and permanent damage to both programs.

Democrats Split As Nancy Pelosi Betrays Seniors

Nancy Pelosi’s irrational behavior regarding the Medicare “doc fix” is creating rifts between Pelosi and other Democrats. For the past several months we’ve had a repeated pattern of the Democrats taking the lead in trying to fix the problem while the Republicans have blocked passage. Suddenly it is Nancy Pelosi who is jeopardizing Medicare.

The Senate passed a six month temporary fix last Friday which differed from the House proposal. While far from perfect, the Senate bill would have at least bought some time to again work on a long term solution. It was initially assumed that the House would quickly approve the Senate bill but instead Pelosi has insisted she will not act upon a Medicare fix which does not also include the jobs proposals in the House bill.

While fighting for the jobs proposals are admirable, this should not be done at the expense of passing the Medicare fix. Failure to pass the fix endangers the Medicare program and will cause seniors, the disabled, and military families to have difficulty getting access to health care. (Medicare directly covers seniors and the disabled while Tricare, which covers active members of the military and their families, bases its fee schedule on the Medicare fee schedule).

As Nancy Pelosi and Harry Reid took differing positions, Politco reported this morning that  Congress battles as Medicare burns. There even appears to be some disagreement with Pelosi among the House Democratic leadership, as reported by The Hill:

Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, tells The Hill that Congress should quickly pass a bill delaying cuts to Medicare physician payments. The comments seem at odds with House Speaker Nancy Pelosi’s (D-Calif.) statement Monday that the House should hold off on taking up the Senate’s Medicare doc fix until the Senate passes a tax extenders bill, which some House members fear might go nowhere if it’s uncoupled from the must-pass doc fix.

“Leverage is less important than ensuring seniors can see their doctors,” Andrews said as he was entering a meeting in the office of House Majority Leader Steny Hoyer (D-Md.). “So I think it’s important to pass it.”

As I said earlier as my Facebook status, also posted to Speaker Pelosi’s FB page (and on Twitter in an abreviated 140 character version):

Nancy Pelosi: We expect Democrats to fight to preserve Medicare, not give Republicans political cover to destroy it. So far it has been the Republicans who have been blocking the payment fix, but if you follow through with threats not to pass the latest temporary fix passed by the Senate the Democrats become responsible for endangering Medicare, and risk losing the senior vote.

Fewer Doctors Accepting Medicare Patients Due To Payment Uncertainties

USA Today reports that “The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.” There have always been doctors who do not accept Medicare due to lower payment rates compared to private insurance but the number is now increasing due to uncertainty about future payments due to the flawed physician payment formula:

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008.

“Physicians are saying, ‘I can’t afford to keep losing money,’ ” says Lori Heim, president of the family doctors’ group.

In past years Congress has acted at the last minute to override steep cuts called for under the payment formula but this year there has been increased uncertainty as the Republicans have repeatedly played politics to prevent a long term fix. If the scheduled 21% cut is not reversed it is anticipated that far more doctors will stop accepting Medicare patients. This cut would place Medicare payment closer to the level of Medicaid, which already suffers from difficulties in access to care.

Medicare not only covers those over the age of 65. The program covers many who are disabled, and the Tricare program which covers U.S. military personnel and their families also pays based upon the Medicare fee schedule.

This year, after attempts at a permanent fix were blocked, the fee cuts have been blocked in temporary measures which have only been effective for one to two months. The Senate finally passed a six month fix last week but payments from June were already being sent out at the reduced rates. The fix would restore the cut fees retroactively but now Nancy Pelosi is threatening that the House will not pass this until the Senate also passes a jobs bill. While a jobs bill is also necessary, these are two separate issues and Medicare beneficiaries should not be forced to suffer while Congressional Democrats are fighting to pass a jobs bill.

SciFi Weekend: Doctor Who: The Hungry Earth, Cold Blood, and The Pandorica Opens

On BBC America Doctor Who completed a two part story, The Hungry Earth and Cold Blood, while the BBC began the season ending two part story with The Pandorica Opens. As usual this review will have major spoilers for the episodes which aired in the United States while saying far less about episodes which have only aired on the BBC.

The Hungry Earth and Cold Blood were excellent stories which also left room open for a sequel taking place one thousand years in the future as well as advancing the season’s arc. The Doctor might have an overly optimistic view of humanity in thinking that a legend of the Silurians returning to share the earth in a thousand years will lead to acquiesce as opposed to a preemptive strike (assuming it isn’t one of those periods in which humans are living in arcs off the planet). Some humans just might not accept any deals the Silurians report which were made with a red head in a short skirt negotiating on behalf of humans.

The shocker at the end is that Rory not only was killed but was taken by the crack in time. Anyone think that the dead Rory might have looked a little plastic? Rory’s body didn’t just fall into the crack but tentacles grabbed him and pulled his body in. As we haven’t seen others fall into the crack we do not know if the other people were taken in such a manner or if something was specifically seeking Rory due to his relationship to Amy and the Doctor. Another question raised is how the Doctor managed to stick his arm through the crack without being pulled in. This might become clearer in the season finale when we will hopefully have a better idea of the purpose of the crack.

The first part began with Amy seeing older versions of herself and Rory in the future waving to them from a distance. The reason for this scene became clear at the end. When Rory went through the crack he was erased from time, although it is not clear why Amy could remember the soldiers who fell through the crack in Flesh and Stone but could not remember her fiance. Hypothetically this could set up a dramatic scene should Rory somehow reappear.

The episode ended with Amy seeing an older version of just herself waving off in the distance, although for a moment she thought she had seen someone else. There is also a bit of debris with a portion of the Tardis, as if it had exploded at some point in time.

The Davies season finales were often over the top, and often the set up episode was far better than the conclusion. The Pandorica Opens is Steven Moffat’s first shot at ending a season. The first part was excellent–as big as the Davies finales while feeling more plausible.  I’ll avoid spoiling the details except to note that many characters who appeared in previous episodes return to tie up the season, and Amy gets to meet Italian men. I do have some questions and nit picks but I can also imagine ways in which they will be resolved in the finale.

Next week: The Big Bang on the BBC while BBC America viewers meet Vincent Van Gogh. My spoiler-free comments on Vincent and the Doctor were posted here.

Democrats Put Significant Resources Into Getting New Voters Out In 2010

The Democrats have two major problems going into the off-year elections: 1) they must defend many seats which have been historically Republican but picked up in the last two election cycles, and 2) they will not have Barack Obama on the ballot to bring in the new voters and young voters who traditionally do not vote in off year elections.

As I noted earlier this spring, the Democrats are attempting to turn out the new voters. Karen Tumulty reported on this in The Washington Post and characterized it as a gamble:

As political gambles go, it’s a big and risky one: $50 million to test the proposition that the Democratic Party’s outreach to new voters that helped make Barack Obama president can work in an election where his name is not on the ballot.

The standard rule of midterm elections is that only the most reliable voters show up at the polls, so both parties have traditionally focused on the unglamorous and conventional work that turns out their bases. But this year, the Democrats are doubling down on registering and motivating newer voters — especially the 15 million heavily minority and young, who made it to the polls for the first time in the last presidential election.

“It’s a great experiment to see whether we can bring out voters whose only previous vote was in 2008,” said Rep. Chris Van Hollen (D-Md.), chairman of the Democratic Congressional Campaign Committee.

The party’s overall budget for reaching new voters is more than twice as big as the $17 million it spent during the tumultuous 2006 midterm, which returned control of both houses of Congress to the Democrats.

If this is a gamble, it is a gamble similar to Howard Dean’s fifty state strategy. The Democrats need these voters to turn out to avoid losing several seats in both Houses and it only makes sense to make the effort to try.

I think it is a safe bet to say that this will not be completely successful. There’s little doubt that young voters and new voters will not turn out as they did in 2008. However this is not a win or lose proposition. The Democrats can benefit if the effort is partially successful and brings out enough voters to tip the vote in their election in some Congressional districts. In addition, keeping such grass roots operations alive helps prepare for the 2012 elections–helping both Barack Obama and other Democratic candidates on the ballot.

Nancy Pelosi Gambles With Future Of The Democratic Party By Rejecting Medicare “Doc Fix”

Harry Reid might be the leader of a House of Congress from Nevada but it is Nancy Pelosi who has turned into quite a gamble–a gamble which if she loses will probably turn the Democratic Party back into a minority party. On Friday the Senate passed a six month Medicare “doc fix” but regrettably could not also pass jobs legislation. Now Nancy Pelosi is threatening that the House will not pass the Senate bill until they also pass jobs legislation.

If her gamble works and the Senate passes the original House bill as opposed to the more limited Senate bill then Nancy Pelosi will come off as a legislative genius. However this is a very high stakes gamble. If she fails then it will be the Democrats who will receive much of the blame for the failure of passage of the Medicare fix.

Failure to pass the Medicare fix will lead to serious limitations on medical care for the elderly and disabled individuals now on Medicare. In addition, Tricare pays based upon the Medicare fee schedule so this will also adversely affect U.S. military personnel and their families.

Conservatives already are beginning to realize that Nancy Pelosi might have handed them a tremendous gift. Ed Morrissey writes:

In other words, Pelosi has handed the Senate Republicans the key to a filibuster not just in the Senate but also in the House, all to demand a massive expansion of the deficit on two separate fronts.  The GOP couldn’t have possibly asked for a better political position even if they had begged Pelosi not to throw them into that briar patch.  And if the “doctor fix” fails to get out of the House, it won’t be Republicans who get the blame, since Pelosi can call a vote on that any time she desires.

Let’s hope that Republicans manage to keep this advantage for as long as it takes Pelosi to realize that she’s blown it.

Morrissey is incorrect on an earlier point claiming, “the passage of the ObamaCare legislation whose financials were specifically predicated on keeping the Medicare reimbursement cuts in place.” A permanent fix was originally planned to be part of health care reform but Republicans made this politically impossible by counting the paper costs of this fix as part of the health care legislation.

Regardless of countless acts by the Republicans to play politics here and block a permanent fix, Morrissey is correct that the Democrats will pay the price politically if Nancy Pelosi is the one to prevent passage of the fix which has now passed the Senate. Loss of the senior vote will be devastating to the Democrats.

New Study Shows Coffee and Tea Reduce Heart Disease

In the Woody Allen futuristic comedy Sleeper it was discovered that everything which we think is bad for us is actually good for us. We will probably never find out that hot fudge is actually good for us, but there has been growing evidence that at least we can continue to drink coffee without guilt. Several studies have already demonstrated benefits from coffee but new studies continue to get attention from the media.

A new Dutch study showed that drinking coffee and tea can reduce the risk of heart disease:

Those who drank more than six cups of tea a day cut their risk of heart disease by a third, the study of 40,000 people found.

Consuming between two to four coffees a day was also linked to a reduced risk.

While the protective effect ceased with more than four cups of coffee a day, even those who drank this much were no more likely to die of any cause, including stroke and cancer, than those who abstained.

Coffee and tea contain a variety of components and most likely some are beneficial and some might not be. It is encouraging to see that the overall effect is beneficial, although this would not apply to everyone. This study has no impact on those who have problems with arrhythmias which are exacerbated by caffeine.

Senate Passes Medicare “Doc Fix”

The Senate finally passed a fix for Medicare payments late on Friday but doctors remain disappointed that they still could not pass a permanent fix for the flawed payment formula due to objection from Republicans. At least this fix extends for six months and, besides preventing an automatic 21 percent pay cut, provides for a 2.2 percent increase. Congressional Democrats have been trying to achieve a permanent fix since last year but the Republicans have successfully blocked every attempt.

Medicare payments were held through yesterday in hopes that the fix would be passed by then. Payments began to be issued today based upon the reduced fee schedule with the increased amount to be paid retroactively once the bill becomes law.  I can recall one time in past years in which this happened. Besides forcing Medicare intermediaries to process the extra payments, this creates extra book keeping headaches for physician offices which must post payments twice and change billings for patient co-payments.

The bill still must pass the House and be signed by President Obama. It is not clear how soon this will be completed and whether Medicare will continue to send payments at the lower amounts or again hold payments pending final passage.

ABC News reviewed the history of the Medicare payment formula:

The cuts in reimbursement stem from a payment formula based on the sustainable growth rate, or SGR, a program Congress set up in 1997 that tied the payments doctors received for treating these patients to the nation’s gross domestic product. But even though the cuts were scheduled to take effect at the turn of the millennium, a series of quick fixes have pushed the schedule back.

Congress has instituted such delays nine times over the past eight years, most recently last April.

When it was implemented, the formula was well intentioned, said Stuart Guterman, assistant vice president at The Commonwealth Fund, an independent research organization. But since then it has misfired, because it doesn’t focus on the reasons behind the rise in spending and specific services that are overpriced.

It’s that formula that needs to be fixed to make the program sustainable, medical professionals concur, rather than simply imposing temporary fixes to override the payment cuts without addressing the root causes of the growth in expenditures.

“We’re left with a choice between a temporary fix that just ‘kicks the can down the road’ without fixing the underlying problem and a 21 percent across-the-board cut in physician fees that would cut primary care as well as specialty care, distort incentives, hurt beneficiaries, and severely damage the credibility of the Medicare program,” Guterman told ABC News. “The recurring cuts in physician fees produced by the SGR formula must be eliminated in order to achieve effective payment and delivery system reforms.”

But many lawmakers are concerned about the costs associated with such a fix. The Congressional Budget Office estimates that over the next two years, such a fix would tack an additional $22 billion to the federal deficit.

While on paper this does add additional money to the deficit, in reality Congress has been passing bills to override the payment cuts for several years and a permanent fix would represent this reality as opposed to adding spending which was not already expected.

The news was not all good today. While it is good news that we won’t have to worry about this for another six months, I fear even greater gridlock next year assuming the Republicans pick up more seats in November. In addition, the Democrats were unable to pass extension of unemployment benefits over Republican opposition.

Republicans Block Medicare Payment Fix

The overall Republican strategy seems to screw up as many things as possible and then try to blame the Democrats. Conservatives have been falsely claiming that ObamaCare is forcing doctors to stop accepting Medicare when it has actually been the Republicans who are to blame. Under the current flawed payment formula, unless Congress votes to override the formula doctors will receive a 21% cut. As action from Congress is required to prevent this, Republicans can (and on several occasions in the past several months have) block passage of bills to prevent the automatic cut despite being in the minority.

Medscape reports that Republicans once again blocked efforts to prevent cuts which technically began on June 1, but which have been postponed by delaying processing of claims so far this month:

In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21% reduction in Medicare reimbursement to physicians and other health providers.

A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.

The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30, rather than for the 19 months mandated by the earlier bill.

It still was not enough, however, to win over the 60 senators needed to end debate on the issue under Senate rules. Fifty-six senators voted in favor, with 40 opposed. Opponents argued that the overall measure was not offset by spending cuts and added too much to the deficit.

Barack Obama had urged Congress to avoid these cuts in his weekly address last Saturday:

More than a decade ago, Congress set up a formula that governs how doctors get paid by the Medicare program.  The intent was to slow the growth of Medicare costs, but the result was a formula that has proposed cutting payments for America’s doctors year after year after year. These are cuts that would not only jeopardize our physicians’ pay, but our seniors’ health care.

Since 2003, Congress has acted to prevent these pay cuts from going into effect. These votes were largely bipartisan, and they succeeded when Democrats ran Congress and when Republicans ran Congress – which was most of the time.

This year, a majority of Congress is willing to prevent a pay cut of 21% — a pay cut that would undoubtedly force some doctors to stop seeing Medicare patients altogether. But this time, some Senate Republicans may even block a vote on this issue. After years of voting to defer these cuts, the other party is now willing to walk away from the needs of our doctors and our seniors.

Now, I realize that simply kicking these cuts down the road another year is not a long-term solution to this problem.  For years, I have said that a system where doctors are left to wonder if….

… they’ll get fairly reimbursed makes absolutely no sense.  And I am committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors.  In addition, we’re already taking significant steps to slow the growth of Medicare costs through health insurance reform – not by targeting doctors and seniors, but by eliminating 50% of the waste, fraud, and abuse in the system by 2012.  This not only strengthens Medicare, it saves taxpayer dollars.

I’m absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path. But I’m not willing to do that by punishing hard-working physicians or the millions of Americans who count on Medicare. That’s just wrong. And that’s why in the short-term, Congress must act to prevent this pay cut to doctors.

If they don’t act, doctors will see a 21% cut in their Medicare payments this week. This week, doctors will start receiving these lower reimbursements from the Medicare program. That could lead them to stop participating in the Medicare program. And that could lead seniors to lose their doctors.

We cannot allow this to happen. We have to fix this problem so that our doctors can get paid for the life-saving services they provide and keep their doors open. We have to fix this problem to keep the promise of Medicare for our seniors so that they get the health care they deserve. So I urge Republicans in the Senate to at least allow a majority of Senators and Congressmen to stop this pay cut.  I urge them to stand with America’s seniors and America’s doctors. Thanks.

Republicans have suddenly become concerned about the deficit after running the government on credit while in power. Not only have they been blocking modest increases in payments, they have blocked efforts at simply keeping Medicare payments at current levels.

Update: Senate Passes Six Month Fix