Could legislation easily passed in the U.S. House that would replace the Medicare Sustainable Growth Rate payment formula for physiciansand implement significant new policies for health information technologybe in trouble in the Senate?
Representatives of two national associations have hopeful but differing views. Steven Stack, M.D., president-elect of the American Medical Association, believes the table is set for passage in the Senate. Jeff Smith, vice president of public policy at the College of Healthcare Information Management Executives, isnt so sure.
The Senate was expected to take up the bill, H.R. 2, after it finished work on a new federal budget but before it adjourned in the early morning hours on Friday. That didnt happen and now both chambers are on recess until April 13.
Stack says the Senate could not resolve procedural issues that would govern consideration of the SGR bill, such as the time allocated for debate and limits on amendments. But he notes that Senate Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Harry Reid (D-Nev.) both pledged to immediately address the SGR upon return and he believes there is widespread support in the Senate.
The bill is the product of a bi-partisan effort that has the support of the pertinent committees in both chambers, and Stack says there are no issues that should stand in the way of quick passage.
Smith at CHIME is a little more cautious. The ducks are not completely in a row in the Senate yet, but even if they were the Senate by principle is not a fast-moving body, and certainly does not let the Housewhich left town on Thursdaydictate its schedule, Smith says. And he worries that the House has dominated the SGR process and there has not been enough face time between House and Senate leaders.
Many Democrats in the House were not pleased that the Hyde Amendment restricting abortions was put in the bill, but let it go, as they also let go a two-year funding extension for the Childrens Health Insurance Program when they wanted four years. Senate Democrats may not be as accommodating, particularly on the CHIP funding, Smith worries. Further, conservative and budget hawk senators are not happy with the price tag of the bill.
That said, Smith was delighted to see how easily the bill cleared the house, with about 90 percent support. And he believes if things get bogged down in the Senate there is a Plan B, which could be another temporary or annual patch on the current program that removes the prospect of a 21.2 percent Medicare payment reduction on April 1.
But until a patch comes, because Medicaid must pay a clean claim within 14 days of the date of service, payment reductions could start in mid-April. It should not be underestimated the burden that will fall on physicians and patients, AMAs Stack cautioned.
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