House Members Seek Adoption of Physician Payment Provision

House members are urging their Senate colleagues to approve a provision in a major health care bill that would prevent a 15 percent cut in Medicare physician payments for the next two years.

Both the House and Senate passed legislation in early August to reauthorize and greatly expand the State Children's Health Insurance Program, or SCHIP, for the next five years. The Senate bill totals $35 billion and does not contain any additional provisions beyond SCHIP reauthorization. The House measure, funded at $50 billion, contains several additional measures, including a provision to provide a 0.5 percent increase in Medicare physician payments in 2008 and 2009. If enacted, the provision would negate steep reductions in Medicare physician payment rates that are scheduled to take effect under the sustainable growth rate, or SGR, in 2008 and 2009.

Members of Congress have only 13 legislative days left before the end of the current fiscal year on Sept. 30, making the House SCHIP provision the most expedient way of stopping the steep payment reductions.

"Given the press of business on both the House and Senate calendars for the remainder of the year, this is the best opportunity to address physician payment," said Kevin Burke, the AAFP's director of government relations.

The Senate passed its SCHIP bill by 68 votes, a veto-proof margin that could be lost if the Senate agrees to an expansion of the SCHIP bill by incorporating physician payment increases, according to some analysts. President Bush has vowed to veto the House and Senate bills, saying that both are too expensive and represent a move toward a single payer health-care system.

House and Senate members are committed to providing positive physician payment updates in 2008 and 2009 but the question is how that will be accomplished.

"The House negotiators are adamant they are not going to have another opportunity to address the SGR in any real way before the end of the (fiscal) year -- that (SCHIP) is the only opportunity," said Burke. "The Senate seems to feel it can get a payment provision together by the end of the fiscal year when they are passing their appropriations bills or tax bills."

Without congressional reauthorization, SCHIP will expire on Sept. 30. Congress, for its part, will have a hard time reauthorizing the program by the Sept. 30 deadline, and as a result, congressional members are likely to extend the deadline for the program's reauthorization.

In the meantime, the House SCHIP bill, also known as the Children's Health and Medicare Protection, or CHAMP, Act, contains other provisions that have raised objections among some physician groups. For example, the bill would prohibit physicians from referring patients to hospitals in which they have a financial stake, prompting concern from the AMA.

"The AMA continues to support physician-owned hospitals as one way to provide patients with high quality care, and we are concerned about restrictions on them in the legislation," said Edward Langston, M.D., AMA board chairman, in a written statement.

"We will continue to work with members of Congress on the physician provisions of the legislation during the conference process, including working to keep the doors open at physician-owned hospitals," Langston vowed.

The CHAMP Act also would require physicians to refer imaging services to accredited institutions and technicians to receive compensation for the services from Medicare. Under the legislation, physicians would not receive Medicare payments for imaging services conducted in their offices, a provision opposed by cardiology groups and others.