Published on August 3, 2007
Contact: Gretchen Schaefer
Phone: 202-354-7131 or 202-236-4410
U.S. House Makes Progress on Physician Payment Issues Prior to August Recess
Washington, D.C.—The College of American Pathologists (CAP) is pleased that the U.S House of Representatives has taken positive steps toward preserving access to health care for seniors. During the final hours prior to its August recess, the House passed legislation that averts negative Medicare physician payment issues faced by pathologists and other physicians.
“We commend the House for passing this legislation that will help protect access to health care for our nation’s seniors by ensuring physicians are compensated adequately,” said Thomas M. Sodeman, MD, FCAP, and president of CAP. “Without this legislation, pathologists will face additional cuts in Medicare physician payments, forcing some to no longer participate in the Medicare program and putting seniors’ access to health care at risk.”
The Children’s Health and Medicare Protection Act of 2007 (CHAMP), H.R. 3162, designed to reauthorize the State Children’s Health Insurance Package (S-CHIP), passed August 1 by a vote of 225-204. CHAMP includes a provision that provides a .5-percent update to Medicare physician reimbursement rates in 2008 and 2009 and eliminates the scheduled 15-percent reduction in Medicare payment to physicians caring for seniors over the next two years, helping to ensure Medicare patients continue to have access to quality care. The 15-percent cut is based on the flawed Sustainable Growth Rate (SGR) formula the Centers for Medicare and Medicaid Services (CMS) uses to calculate Medicare reimbursement payment to physicians.
Last December, Congress passed The Tax Relief and Health Care Act of 2006, H.R. 6111, which stopped a 5-percent Medicare physician payment cut for 2007. The 2008 proposed physician fee schedule from CMS includes a 9.9-percent cut based on the SGR and a projected 15-percent cut through 2009.
H.R. 6111 also extended the expiring “TC Grandfather” through 2007. In 1999, CMS issued a final notice that Medicare would no longer pay independent laboratories for the technical component (TC) of pathology services provided to hospital inpatients and outpatients. To date, this payment change has not been fully implemented because the College has successfully won passage in Congress of a series of temporary TC “grandfather” exemptions, and in 2003, under the Medicare Modernization Act, Congress provided a “grandfather” through 2006.
CHAMP also would extend the TC grandfather through 2009, which would provide the stability independent laboratories and hospitals need to maintain surgical diagnostic services vital to Medicare beneficiaries.
A Senate bill reauthorizing S-CHIP, The Children’s Health Insurance Program Reauthorization Act of 2007, S. 1893, passed last night by a vote of 68-31 but does not address Medicare physician payment issues.
Both legislative packages will be consolidated into a single bill during a conference session in September and will then go to President Bush.
“We are hopeful that the Senate will concur with the House provisions on Medicare physician payment issues,” Sodeman said. “Additionally, we hope Congress will extend the TC grandfather that will help cash-strapped hospitals—many in rural areas—pay for laboratory services.”
The College of American Pathologists (CAP) is a medical society serving about 16,000 physician members and the laboratory community throughout the world. It is the world’s largest association composed exclusively of pathologists and is widely considered the leader in laboratory quality assurance. The CAP is an advocate for high quality and cost-effective patient care.