House wants administration buy-in to Medicare pay fix

Republicans on the House Ways and Means Committee renew their call for Medicare regulators to take a role in reversing physician cuts.

By David Glendinning, AMNews staff. Aug. 1, 2005.

Washington -- Congress has accepted the fact that it needs to scrounge up a large chunk of money to repair Medicare physician pay, but some lawmakers say the Bush administration must put in its fair share, too.

House Ways and Means Committee Chair Bill Thomas (R, Calif.) and Health Subcommittee Chair Nancy Johnson (R, Conn.) for more than a year have been calling on Medicare officials to pursue administrative changes that could take some of the budgetary pressure off Capitol Hill. If left unchanged, the physician formula would cumulatively cut doctors' reimbursements by more than 25% over the next six years.

Thomas and Johnson reiterated their belief that the administration must chip in to restore these payments in a pointed letter that they recently sent to Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD.

"A permanent legislative fix to the [physician payment] formula would be prohibitively expensive given current interpretations of the formula but could proceed through our joint efforts combining administrative and legislative actions," they stated.

The belief that CMS has an important role to play in this process is grounded in the assertion that the agency determines physicians' payments by accounting too much for some medical services and not enough for others.

On one end, biologics and physician-administered drugs such as chemotherapy treatments are not reimbursed through the physician fee schedule but nevertheless register as doctors' services, Thomas and Johnson wrote. The disconnect artificially drives physician expenditures above predetermined annual limits and triggers Medicare rate cuts in future years, they said.