Baucus Sets Forth with Medicare Reform

Washington, DC — The Senate Finance Committee Chairman, Max Baucus (D-Mont.), on Friday unveiled legislation making reforms to Medicare. The Medicare Improvements for Patients and Providers Act of 2008 has many changes including that of a delay of the physician cut that was to begin July 1.

Baucus expects the bill to move straight to the Senate floor for consideration this month, and intends to work together with colleagues on both sides of the aisle for its bipartisan passage, according to a press release.

“(This bill) gives doctors a decent, measured increase in reimbursement that doesn’t explode costs or excessively raise premiums. And it makes smart changes to stop overpayments to private plans that are getting more than their share of taxpayer dollars,” Baucus said in the release.

See a section-by-section summary of the Act here. 

This bill also proposes to revoke “unique authority” of the Joint Commission to deem hospitals in compliance with Medicare Conditions of Participation Proposal on Pay for Medicare Providers.

According to the bill, the verbiage listing exclusively the Joint Commission is being replaced with “accredited by a national accreditation body recognized by the Secretary under section 1865(a) of the Social Security Act, or is accredited by or approved by a program of the country in which such institution is located if the Secretary finds the accreditation or comparable approval standards of such program to be essentially equivalent to those of such a national accreditation body.”

Other measures specific to physician payment and outpatient healthcare include:
>>Blocks a cut in physician payments for Medicare services, and increases payments by 1.1 percent in 2009.
>>Extends and increases the Physicians’ Quality Reporting Initiative (PQRI) bonus for providers who measure and report on quality of care
>>Provides incentives to doctors who move to safer, more reliable electronic prescribing methods, decreasing payments to doctors who fail to do so by 2011
>>Increases payment for primary care services in shortage areas, corrects a reduction applied to physician work, and adds new funding and authority for the Medical Home Demonstration Project
>>Extends an increase in the geographic adjustment to payment for physician work in rural areas
>>Extends rules allowing independent laboratories to bill Medicare directly
>>Helps physicians called to active military duty receive Medicare payments they’re owed
>>Implements an accreditation requirement for diagnostic imaging providers and tests the use of appropriateness criteria for such services
>>Pays teaching anesthesiologists a full reimbursement for each patient under their care, and comparable treatment of nurse anesthetists as well 

Additional provisions clarify the proper research uses of Medicare drug benefit data and address issues of quality reporting and health disparities. The bill also contains a number of improvements and extensions related to the Medicaid program, most notably a delay in the implementation of changes to “Average Manufacturer Price” calculations that would slash payments to pharmacies for dispensing generic drugs.

In addition to the staff legislative summary, more detailed information on key aspects of the bill — help for rural seniors and all beneficiaries, physician provisions, bundling of dialysis payments for ESRD, Medicare Advantage reforms, and other measures — is on the Finance Committee Web site located here.

For more on how it affects the dialysis industry, click here.

Source: Senate Finance Committee