A showdown between President Bush and Congress over Medicare physician payments concluded Tuesday when the House and Senate overrode the president's veto of HR 6331. The aftermath brings relief to physicians until 2009 and could have significant long-term implications for radiologists and imaging practice. The House passed the Medicare Improvements for Patients and Providers Act of 2008 June 24, followed by Senate passage July 9. Bush vetoed the bill July 15, saying the proposed $13 billion in cuts to private insurers to offset the 10.6% payment cuts to physicians that HR 6331 negated would discourage patient participation in Medicare Advantage programs and reduce care options for the elderly. Advocacy groups representing physicians, industry, and consumers, such as AARP, argued that reimbursement cuts to physicians would have forced them to drop Medicare patients. These organizations, along with the American Medical Association and the American College of Radiology, lobbied aggressively for the bill and secured such strong bipartisan support that the override vote of 383 to 41 in the House and 70 to 26 in the Senate surpassed support generated on other votes necessary to pass the bill. Besides averting physician payment cuts for the next 18 months, the Congressional victory means that the imaging provisions in HR 6331 -- accreditation requirements for providers of advanced diagnostic imaging services and a voluntary appropriateness criteria program -- will become reality, said Joshua Cooper, senior director of government relations for the ACR. "(The new law) also gives the next Congress breathing room and, hopefully, enough time to start on a real reform that may include physician payments," Cooper told Diagnostic Imaging. The imaging provisions contained in the bill boost ACR's long-held assertions that imaging should be done by qualified people and should not be overutilized, according to Cooper. Congress could have just done another extender package similar to what they did back in December, but they chose to be proactive and implement new programs. That bodes well for the coming Congress and indicates that legislators are serious about trying to pursue further reforms in Medicare, Cooper said. "I hope to see more bipartisan work. Medicare and healthcare should not be a partisan issue," he said.
Patients and physicians welcomed several highlights of the new bill:
- copayment waivers for certain healthcare services
- a ban on shady marketing practices aimed at sellers of private Medicare plans
- more benefits for rural areas
- improved mental healthcare access for veterans
- a boost to rewards in the Physicians Quality Reporting Initiative
- incentives to physicians who adopt electronic reporting methods by 2011
- enhanced Medicare drug prescription benefits
One key provision in the bill stirred controversy on the Hill. Section 161 will gradually eliminate double disbursement known as Indirect Medical Education payments given to Medicare Advantage plans that send patients to teaching hospitals. Medicare will still pay teaching hospitals directly as in the past, but they will lose the extra money.
"The true impact of this measure is yet to be seen," said Orrin Marcella, ACR director of congressional affairs. For more information from the Diagnostic Imaging archives: Congress overrides White House veto of physician payment bill White House makes moves to veto Medicare physician payment bill Senate passes Medicare bill to avert physician payment cuts CMS calls for temporary hold on Medicare cuts