Senate fails to pass legislation to avoid physician payment cuts

Congress may not meet a July 1 deadline to avoid a 10.6% cut in Medicare physician payments after the Senate fell two votes short of the 60 needed late June 26 to cut off debate clearing the way for a final decision on the floor.

Despite dire predictions, the bill may be back for a vote after the July 4th recess.

"We are disappointed that this issue couldn't be addressed prior to the July 1 implementation of the physician payment cuts," said Timothy P. Trysla, executive director of the Access to Medical Imaging Coalition.

AMIC represents more than 75,000 U.S. physicians, healthcare providers, and patient organizations. It was founded soon after Congress passed the Deficit Reduction Act of 2005.

"That sentiment is shared throughout the physician and healthcare community," Trysla told Diagnostic Imaging.

Forty-seven Democratic, nine Republican, and two Independent senators (Lieberman-CT, Sanders-VT) voted in favor of cloture for the House version of a Senate bill that had also failed last week to garner the votes needed to go ahead with limited debate.

The Medicare Improvements for Patients and Providers Act (HR 6331) passed the House June 24 by a tally of 355 to 59. It was almost identical to S 3101, the Senate bill that stalled June 12. S 3101 sought to replace payment cuts of 10.6% scheduled by Medicare's Sustainable Growth Rate formula for July 1 with a 0.5% increase for the remainder of 2008. It would also have replaced an additional 0.5% cut set to go into effect on Jan. 1, 2009 with a 1.1% raise.

HR 6331 addressed many concerns raised by Senate Republicans about S 3101, particularly those regarding proposed cuts to the Medicare Advantage plans to offset the payment cuts in the SGR formula. The Bush administration has threatened to veto any legislation that undermines funding for these privately run plans.

Thirty-nine Republican senators opposed cloture on HR 6331. Two senators, John McCain (R-AZ) and Edward Kennedy (D-MA), did not vote. Following procedural rules, Senate Majority Leader Harry Reid (D-NV) changed his vote at the last minute from aye to nay in a procedural move that allows him to reintroduce the bill after the recess.

Physician advocacy groups such as the American Medical Association had warned that bringing payment cuts into effect would force nearly two-thirds of U.S. physicians to limit the number of new Medicare patients they treat. More than half of doctors would have to lay off staff, and about one in 10 would quit patient care altogether, according to an AMA statement released shortly before the Senate vote.

Congress can still pass legislation to restore payment rates retroactively. Insiders see that option as an administrative nightmare because there is no end in sight to the stalemate in the Senate. Trysla is cautious but confident that Congress will again address the issue.

"CMS has the ability to hold payments and hold physicians harmless. It's a matter of timing of the action by Congress and the president," he said. "But if Congress doesn't act promptly, that window of opportunity to hold physicians harmless gets smaller and smaller."

For more information from the Diagnostic Imaging archives:

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Congress may not find fix for impending Medicare physician rate cut