News in brief - Aug. 1, 2011

Senators oppose Medicare imaging cuts

A bipartisan group of six senators has urged the Obama administration to rethink its plans to impose cuts on Medicare payments for certain imaging services.

The senators are concerned that the projected savings from the imaging cuts could be used to offset new federal spending or to reduce federal budget deficits. Instead, the administration should work to enact alternative reforms that promote clinical decision-support systems in Medicare, they said.

"These cuts are stifling this homegrown medical innovation and leaving seniors and disabled Americans without access to the care they need to diagnose and treat life-threatening diseases such as heart disease and cancer," states a July 20 letter to the White House from Sens. John Kerry (D, Mass.), Lamar Alexander (R, Tenn.) and four others.

The Centers for Medicare & Medicaid Services has proposed reducing pay to physicians interpreting multiple advanced diagnostic imaging services provided to the same patient on the same day. The cut is outlined in a provision in the proposed 2012 Medicare physician fee schedule. Some physician organizations, including the American College of Radiology and the American College of Cardiology, have come out against the proposal.

CMS is gathering comments on the fee schedule and is expected to finalize the rule in November.

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HHS funding bills probably delayed until after August break

Congressional appropriations committees are not expected to mark up legislation to fund the Dept. of Health and Human Services for fiscal year 2012 until after Congress returns from its district work period in early September.

In late July, the House Appropriations Committee indefinitely delayed a legislative markup of HHS funding legislation that had been scheduled for July 27. The Senate Appropriations Committee had not scheduled an HHS appropriations bill hearing at this article's deadline.

The delay means Congress again may need to adopt a short-term funding extension to keep HHS -- and possibly other federal agencies -- running during the first part of fiscal year 2012, which begins Oct. 1. Negotiations over increasing the nation's statutory debt ceiling have consumed a great deal of lawmakers' time and effort, leaving less time to conduct regular hearings and markups, according to a Senate Appropriations Committee spokesman.

The House and Senate are scheduled to adjourn on Aug. 8. The Senate would return on Sept. 6 while the House would return the following day, leaving just weeks before the end of fiscal 2011 to send an HHS appropriations bill to the White House.

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Senate committee approves ban on generic drug delays

The Senate Judiciary Committee on July 21 voted 10-8 to approve a bipartisan bill that would prohibit settlements between brand-name and generic drug manufacturers that dictate when generic versions of brand-name drugs can be introduced. The measure would give the Federal Trade Commission clear authority to intervene in patent settlements that include "anti-competitive provisions," including "pay-for-delay" agreements in which a brand-name manufacturer compensates a generic drugmaker for holding off on introducing a generic medication.

"This is an important step in making sure that there's no room in a competitive marketplace for these kinds of backroom deals," said Sen. Herb Kohl (D, Wis.), the bill's lead sponsor. The measure also is sponsored by Sen. Charles Grassley (R, Iowa), the highest-ranking Republican on the Judiciary Committee. President Obama included a similar ban of such settlements in his fiscal year 2012 budget request. The Congressional Budget Office estimated the Kohl bill would save the federal government, which pays about a third of all prescription costs, $2.7 billion over 10 years.

The Generic Pharmaceutical Assn. said it was disappointed in the Judiciary Committee vote. The FTC and bill authors misunderstand the purpose and effect of such patent settlements, the association said. Of the 23 new generic drugs expected this year, 17 were made possible by settlements of patent lawsuits that could have lasted much longer if fully litigated, according to the GPhA.

Also, the association said, the FTC already has authority to review and reject patent settlements the agency deems unlawful. Bill sponsors said patent settlements did not include pay-for-delay provisions before 2005. Since then, three appeals courts have prevented the FTC from taking action against these settlements.

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Senator aims to preserve Medicare pay for frontier states

Some western states would lose tens of millions of dollars in Medicare payments if a certain health system reform law provision is repealed, said Sen. Kent Conrad (D, N.D.).

The so-called Frontier Amendment in the law increases Medicare pay for physicians and other health professionals practicing in Montana, Nevada, North Dakota, South Dakota and Wyoming. The provision has provided an additional $16 million to doctors and $52 million to hospitals in North Dakota alone, Conrad wrote in a July 18 letter to Vice President Joe Biden.

House Majority Leader Eric Cantor (R, Va.) proposed repealing the amendment during deficit reduction negotiations with the Obama administration. Conrad requested that the provision be taken out of discussions to lower the deficit.

"The Frontier Amendment helps ensure continued access to high-quality and affordable medical treatment for all North Dakotans," said Tim Blasl, vice president of the North Dakota Hospital Assn.

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Illinois physicians sue to stop out-of-network law

A group of Illinois physicians has filed a federal lawsuit against the state, seeking to overturn a new law that shifts the burden of certain patient costs from insurers to doctors.

The legislation, which took effect June 1, prevents some out-of-network specialists from billing insured patients for anything other than the co-pay that would apply if the doctor were in-network. According to the statute, the out-of-network physician or hospital must seek any remaining balance from the patient's insurer, despite being out-of-network, and cannot bill the patient. The law applies only to physicians practicing anesthesiology, emergency medicine, neonatology, pathology or radiology.

In their June 24 lawsuit, filed in the U.S. District Court for the Northern District of Illinois, the doctors claim that the law infringes on their constitutional rights. The law also unfairly singles out certain specialists, while other general practice physicians are unaffected, they said. The plaintiffs are asking for an immediate injunction to stop the law.

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