March 19, 2014

Congress Grapples With Primary Care Pay

By David Pittman, Washington Correspondent, MedPage Today

While Congress is grappling with the myriad of issues that make up the budget, a quantum change in the annual ruckus around RVU payment amounts may be changing, maybe for the better, but that may depend on your specialty. We suggest physicians stay up on what’s happening, stay in touch with your legislators and make them hear what the real practice of medicine is like, and what the impact of these prospective changes will be in your office.

WASHINGTON – Some Democratic lawmakers have expressed interest in extending the pay increases for primary care physicians in Medicare and Medicaid that are temporarily in effect under the Affordable Care Act (ACA).

The measure to continue the pay increases — which could come in legislation that repeals Medicare’s sustainable growth rate (SGR) payment formula – faces a tough battle as a budget conscious Congress works to keep an SGR repeal price tag low.

The ACA gave select Medicare primary care services a 10% bonus between 2011 and 2015 and set Medicaid primary care payments on par with those of Medicare in 2013 and 2014. The law defined primary care as general pediatrics, general internal medicine, and family medicine. “It’s early to really evaluate what impact those bonuses have had on access to care,” Del. Donna Christensen, MD (D-V.I.) said at a House Energy and Commerce Committee hearing Thursday.

“Some people would argue that we need more data before we decide to go forward with continuing this policy, which might set up a Catch-22 because under current law the policy will end before we might have adequate data.”

Democratic leaders including Reps. Henry Waxman (D-Calif.) and Frank Pallone (D-N.J.), the top two Democrats on the Energy and Commerce Committee and its health subcommittee, supported the idea of primary care pay bumps. Republicans, on the other hand, didn’t endorse the idea at the hearing.

However, Thursday’s hearing wasn’t just about primary care pay bonuses. It sought to evaluate certain expiring Medicare and Medicaid programs typically extended through an SGR patch that mostly helps low-income hospitals, families, and individuals receive additional support. These “extender” programs are typically renewed annually with an SGR patch delaying Medicare pay cuts — a patch which Congress has passed annually for more than a decade. Without a patch or the SGR repeal Congress is working to make a reality this year, there would be no vehicle through which to extend such policies.

“In our current budget climate and with the Medicare Trustees predicting insolvency as early as 2026, hard decisions will have to be made,” Health Subcommittee Chair Joe Pitts (R-Pa.) said in his opening statement. “Any determination that a policy should be made permanent must be based on data-driven analysis that justifies the extender’s continued existence.”

Congress has set a goal to have an SGR repeal passed by March 31 — the date a 3-month patch to ward off scheduled pay cuts under the SGR is set to expire. “The cake is literally in the oven baking,” Rep. Mike Burgess, MD (R-Texas), said at Thursday’s hearing.

Whether or not the primary care pay bumps in Medicare and Medicaid make it into the final bill remains to be seen. The extra money would obviously increase the cost of an SGR repeal, and lawmakers are already battling over a price tag around $120 billion — which isn’t just loose change around Washington.

Examples of other Medicaid and Medicare extender programs receiving attention include:

The Qualifying Individual program, which helps low-income seniors pay their Medicare Part B premiums
Transitional Medical Assistance, which provides additional Medicaid coverage to those who may cycle in and out of the program because of household income fluctuations
Children’s Performance Bonus Payments, which provides bonuses to states who simplify enrollment processes in Medicaid and Children’s Health Insurance Program
Medicare adjustment for low-volume hospitals, which helps rural hospitals stay financially solvent despite low admissions
Maternal, Infant, and Early Childhood Home Visiting Programs, which provide maternity home visits for women with young children

The SGR repeal-and-replace bill the House Ways and Means Committee passed last month does not include an extension of such Medicare policies. An exact dollar amount of the extenders polices is unknown as it depends on which policies are extended and for how long, a committee staffer said. But it is believed to cost in the tens of billions of dollars.

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