Senate Finance Chairman Max Baucus told a group of physicians today that he wants to increase payments to primary care physicians and tie reimbursements to quality as part of a Medicare bill expected on the Senate floor in mid-May. “The physician community does believe that reimbursement should be based more on quality, whether it’s outcomes, results, or what not. They know that. They’re just a little bit nervous about how it’s done,” Baucus said after addressing the group in a closed-door meeting. A committee aide said he also took several questions from the attendees, who were present by invitation only. Chief among the participants’ concerns is the funding scheme that would temporarily stop a 10 percent physician pay cut from going into effect. Baucus wants an 18-month patch that would set up a 20 percent pay cut on Jan. 1, 2010. The future pay cut makes many physicians uncomfortable, but Baucus assured the group that he would address the funding mechanism more broadly next year and not let that 20 percent pay cut go into effect, the aide said. “They understand that that’s the reality,” Baucus said. Meeting with physicians face to face “gives us both comfort level that this is the right thing to do,” Baucus added. Another meeting may be scheduled as the committee continues drafting the bill.
The American Medical Association was not invited to the meeting, chiefly because it has protested the financing mechanism that imposes higher pay cuts in the future. Baucus told the group he needs physicians’ help to sell the financing mechanism as part of the bill. “My goal is to advance the ball on payment reform, be open and transparent, notably to those who kind of like what I’m doing as well as those who don’t like what I’m doing,” he said. “It’s not going to be a big bill. It’s 18 months, and we’re limited by a pay/go requirement.” The bill under discussion will cost roughly $8 billion over five years, which barely covers the cost of an 18-month reimbursement patch and leaves little room for extra provisions. Although the committee had considered several Medicaid provisions the last time they negotiated a bill, Baucus said today he is unsure whether Medicaid will be addressed in the Medicare bill. Baucus wants to include electronic prescribing requirements, but he needs the physicians to sign off on the proposal. At the meeting, physicians raised concerns about a bill sponsored by Sens. John Kerry, D-Mass., and Debbie Stabenow, D-Mich., saying its pay incentive was too steep, a committee aide said. Lawmakers will tinker with the e-prescribing bill to ensure as much buy-in from physicians as possible.
On primary care physicians, Baucus said he wants to increase their pay under Medicare, but he is responsive to concerns from specialty physicians that their pay will be reduced by the same amount, as the Medicare Payment Advisory Commission has recommended. Baucus also wants to expand an HHS three-year demonstration project promoting “medical homes” — physician practices in underserved areas that reach out to potential beneficiaries and coordinate their health care.
This article appears in the April 12, 2008, edition of National Journal Daily PM Update.