Medicare regulatory relief bill gets first congressional airing

Physicians say that Medicare's paperwork burden is driving doctors away; the government fears the relief bill would aid the small number of bad actors.

By Gina Shaw, amednews correspondent. April 2, 2001.

Washington -- In its first congressional vetting, legislation designed to alleviate Medicare's regulatory burden on physicians seemed to resonate with several lawmakers. But some representatives and government officials remain wary of the proposal.

The bill, dubbed the Medicare Education and Regulatory Fairness Act of 2001, was the subject of a March 15 House Ways and Means health subcommittee hearing. The panel's chair, Nancy Johnson (R, Conn.), said she hears "every day" from physicians and other health care professionals in her district that the regulatory burden currently imposed by the 130,000 pages of Medicare regulations is "not only unacceptable, but destructive."

AMA President-elect Richard F. Corlin, MD, agreed. "Physicians are creating documentation in their patients' charts often not for the benefit of the patient's care, but purely to meet the government's demands," he said.

Just days earlier, Dr. Corlin noted, he'd been the physician on-call to treat a hemorrhaging patient in a hospital's intensive care unit, and he found himself wasting precious time sorting through more than 30 pages of chart documentation that was, for the most part, medically unnecessary. "A few years ago, I would have been able to get the same patient information in just a four- or five-page chart, but today it takes 30 pages or more to comply with Medicare regulations," he said.

That didn't surprise Rep. Jim Ramstad (R, Minn.), who told the committee that until recently, the most consistent complaints he'd received from his constituents had to do with the Internal Revenue Service. "For the last couple of years, I've gotten the most complaints about [the Health Care Financing Administration]," he said.

The regulatory relief bill, co-sponsored by Reps. Pat Toomey (R, Pa.) and Shelley Berkley (D, Nev.) and supported by nearly 60 co-sponsors, would cut back on the regulatory burdens imposed by Medicare without impeding investigation into genuine cases of fraud, Dr. Corlin testified. More than 50 medical and specialty organizations support the legislation. It aims to bar carriers from collecting alleged Medicare overpayments while audit findings are under appeal, ensure that physicians do not have to comply with proposed Medicare rules until they are final, enable physicians and others to challenge the constitutionality of Health and Human Services regulations, and allocate funds toward education efforts focused on compliance with regulatory requirements.

The current system of cumbersome, confusing and inconsistent regulations and the application of those rules are driving good physicians out of the Medicare system, health care groups testified.

"I can tell you that in virtually every community where I speak, one or two senior internists tell me, 'I've had it. I'm not going to see Medicare patients anymore,' " Dr. Corlin said.

Some doubters

Rep. Fortney "Pete" Stark (D, Calif.), the ranking Democrat on the Ways and Means Committee, challenged that statement, sounding less than sympathetic toward what he called "poor overburdened providers." In every state except Missouri, the rate of physicians participating in Medicare was higher in 2000 than in 1999, Stark said.

A Medicare Payment Advisory Commission survey showed that only 4% of physicians had difficulty finding referrals for Medicare patients, while 7% had difficulty finding referrals for patients with private insurance, he added.

Rep. Gerald Kleczka (D, Wis.) echoed Stark's skepticism, saying doctors and other professionals "can't blame all [their] woes on HCFA."

Stark said Medicare had a better record with physicians than many private health plans. "I'm not suggesting we can't improve, but I don't think you'd ask me to turn this over to Aetna and let them pay all your claims," he said.

But Dr. Corlin and others on the panel of health care organizations -- which included representatives of the American Hospital Assn., the American Health Care Assn. and the Home Health Care Assn. -- universally agreed that compliance with Medicare regulations creates a far more serious burden than dealing with private payers.

"At least with managed care, we can get an answer and we know the rules," Dr. Corlin said. "But with Medicare, we're constantly faced with uncertainty and inexactitude. All we want is for the audit process to be efficient, appropriate and businesslike."

It's not that simple, testified George F. Grob, deputy inspector general in the HHS Office of Inspector General. Although HHS supports some aspects of the regulatory relief bill, particularly expanded education for physicians and other health professionals, Grob claimed that many of the bill's proposals would promote fraud.

"It is obvious that parts of the proposed bill are intended to assure honest providers that they will not be subject to investigation, prosecution or harassment as a result of good-faith efforts to comply with Medicare requirements," Grob said. "Unfortunately, many of these same provisions would play into the hands of the small number of unscrupulous individuals who use sophisticated means to exploit weaknesses in the Medicare program."

Still, Grob admitted, much of the HCFA regulatory system is in need of reform. The appeals and grievances process, in particular, is ill-prepared to handle the needs of physicians and other health care professionals in today's health care marketplace, he said. "Overall, the system has few champions and needs a top-to-bottom overhaul."

Rep. Jim McDermott, MD (D, Wash.), a psychiatrist, appeared interested in the medical community's thoughts on regulatory relief demonstration projects. "I was in practice when we put in the DRG system, just bang! What kind of pilot testing would allow HCFA to figure out what they need to prevent and prosecute fraud without running roughshod over health care providers?" he asked the witnesses.

In response, Dr. Corlin described a multitiered system of pilot testing that would include teaching hospitals and rural settings.

"If fraud occurs, prosecute it, and we'll be there clapping," concluded Dr. Corlin.

"[The bill] doesn't impede that in any way. These are incremental, modest reforms that should provide immediate relief to providers and help ensure that patients continue to have access to a wide range of physicians and providers in the Medicare program."