College of American Pathologists
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March 4, 2010  •  Volume 26, Number 5
Next Issue: March 18, 2010
© 2010 College of American Pathologists

In This Issue:

Medicare Physician Payment Cuts Averted for Another 30 Days
CAP News Analysis: Healthcare Reform Faces Tough Road to Reconciliation
More States Consider Licensing Genetic Counselors
CMS Releases Revised Guidance on EHR Rules

Medicare Physician Payment Cuts Averted for Another
30 Days

After more than a week of grandstanding and political wrangling in the Senate, the 21% Medicare physician pay cut has been averted for another 30 days, taking the most recent fix through the end of March 2010.

Congress allowed a previous fix to expire on February 28, creating uncertainty in the physician community and causing CMS contractors to hold all claims for services provided from March 1-10. After the 30-day extension was announced, CMS reversed that order, instructing Medicare contractors to release claims with dates of service March 1 and later for processing and payment.

This latest 30-day extension until March 31, 2010, will give Congress time to pass a longer term fix, averting the 21% Medicare physician pay cut in 2010 and overriding the federally mandated Sustainable Growth Rate (SGR) formula to calculate physician payment. Without continued Congressional intervention or actual repeal of the SGR, physicians face pay cuts of 40% in the next several years.

Senate Plans For SGR and TC Grandfather Fix

With the clock already ticking toward the March 31 deadline, the Senate is now considering legislation (H.R. 4213), a jobs-related bill entitled the Tax Extenders Act that would likely be used as a vehicle for a longer term SGR fix. This legislation would also be a vehicle to reinstate the technical component (TC) “grandfather.”

Senator Max Baucus, Chairman of the Senate Finance Committee, has offered an amendment to H.R. 4213 to address a number of health care related issues, including the SGR and TC “grandfather.” The Baucus amendment proposes a 7 month SGR fix which would halt Medicare physician payment cuts until September 30, 2010. The amendment also proposes to extend the TC “grandfather” until December 31, 2010. The “grandfather” would be made retroactive to January 1, allowing claims over the past few months to qualify under the “grandfather” payment policy.

As of this writing, the amendment has not been brought to a vote so the length of the proposed extension to avert the physician payment cut and continue the TC “grandfather” could be subject to change. However, the amendment appears to have the votes to pass and the Senate is likely to act on final passage of the bill before the current SGR fix is set to expire, March 31. Once the Senate passes the bill, the House will have to follow suit before it can be signed into law. Timing on House action is unclear.

MedPAC Recommends Physician Payment Increase for 2011

Meanwhile, the Medicare Payment Advisory Commission, (MedPAC) released its semi-annual report on Monday, with a recommendation to increase Part B payments, including physician payments, by 1% in 2011, amounting to a ½% increase for physicians.

MedPAC based its recommendation on a survey of Medicare beneficiaries which revealed some beneficiaries who sought new physicians experienced difficulty finding one.

Physician groups have argued that Medicare payment cuts will impact patient access to care, as physicians find it increasingly difficult to participate in the Medicare program.

CAP News Analysis: Healthcare Reform Faces Tough Road
to Reconciliation

As if the differences between Republicans and Democrats weren’t enough to derail any piece of legislation, the President’s hopes for passing healthcare reform face two even more daunting challenges right now: opposing views among Democrats on key issues, and strain between the House and the Senate Democratic leadership on how to proceed. Add to that the political high jinx and delay tactics for which Congress is notorious, and you have all the makings of a very bumpy ride to approval. At least most Washington insiders agree it will either go relatively quickly from this point forward, or it won’t go anywhere.

For now, there are more questions than answers.

Q. What will Healthcare Reform include?

A. No one is sure...
But under the plan taking shape, the House would pass the health care reform bill approved by the Senate Christmas Eve. The House-passed bill would be set aside. Both the House and Senate would then pass a reconciliation bill that consists of changes being negotiated by Democrat leaders to address concerns of House members with the somewhat smaller and more moderate Senate bill.

Overall, both the House and Senate-passed bills would extend coverage to 30 million uninsured Americans over 10 years with the establishment of insurance exchanges for individuals and small businesses to purchase insurance, a first-time mandate for nearly everyone to buy insurance, and a host of new requirements on insurers and employers. The Senate bill is less costly than the House bill.

The President has indicated his support for a legislative strategy that includes a budget procedural known as reconciliation which would protect a final health care reform bill from Republican filibuster in the Senate. Without such protection, 60 votes would be needed to pass health care reform in the Senate. With the election of Massachusetts Republican Scott Brown to the Senate, Democrats could not muster this supermajority. Although Obama has reached out to Republicans and backed the inclusion of several Republican supported provisions that came out of last week’s bi-partisan health care summit, Republicans do not think these changes address their concerns about the bill’s fundamental approach to reform. (See the President’s letter to Congress.)**

Among the main points of contention between the House and Senate bills are creation of a public insurance option; language preventing the use of federal funds to pay for abortions; immigration, and the excise tax on high-cost health plans.

Q. How will these issues be resolved?

A. That is the $64,000 question...
House leaders have said they would not have the votes to pass the Senate bill as it is. Senate Democrats face a similar fate, with the election of Senator Scott Brown (R-MA) giving GOP lawmakers the ability to indefinitely block the bill’s progress through filibuster.

This is where the possibility of “reconciliation” comes in. The President alluded to it when he called for a ‘thumbs-up or thumbs-down’ vote. Reconciliation permits Senate leaders to move legislation quickly, limiting debate to 20 hours in the Senate, with no filibuster, and passage requiring only a simple 51-vote majority. However, in order to qualify for reconciliation, a bill must be designated as part of the budget process. The requisite connection to fiscal objectives makes reconciliation a difficult tool for making large scale changes to the Senate’s existing bill, as some House Democrats are demanding.

In addition, Republicans have denounced the use of reconciliation for healthcare reform. Fearing the political fallout during the next election cycle, Senate leaders are hesitant to take this step without assistance from House Democrats.

According to a staffer close to the negotiations, the most likely scenario is that the Senate will prepare a letter, signed by at least 51 Senate Democrats, pledging to vote for the fixes that most House Democrats want to see in the bill.

Once House members get assurance the Senate has the votes for a House-friendly “side-car” bill, they will have to pass the original Senate bill and a sidecar bill with the agreed fixes, and the Senate will have to pass just a side-car bill through reconciliation.

Q. What is the timeframe?

A. More interesting possibilities...
It may feel like we’re at the end of the road, but in reality if Senate Republicans delay the process by introducing and debating countless amendments this could go on through the August recess and into the fall elections.

Democrats appear to be trying to move quickly, with Sen. Reid seeking to have the House pass its reconciliation bill by March 26, just before Congress’s Easter recess. This would allow the Senate Majority Leader to leave debate on the bill open during the recess when many Senators won’t be Washington.

CAP Advocacy staff continues to monitor this important legislation and will continue to keep CAP members informed.

** (Among the Republican-inspired provisions the President identified was a $50 million appropriation to provide incentives for states to pursue a wide range of liability reforms to resolve medical malpractice disputes. This is an issue on which CAP urged the President to seek agreement before the bi-partisan healthcare reform meeting last week.)

More States Consider Licensing Genetic Counselors

State legislatures in Michigan, Minnesota, Rhode Island and Pennsylvania are all considering bills to license genetic counselors in 2010. In addition, Illinois is considering legislation to expand the licensure authority of genetic counselors. CAP is working with all of these state pathology and medical societies to advise on the legislative language of individual bills, and to ensure a clear delineation between the role of genetic counselors and physicians with respect to providing medical interpretations of genetic testing results, or authority to order such testing.

The CAP believes genetic counselors perform a valuable role in counseling clients and families on the advisability or results of genetic tests, and genetic counselors should be able to review genetic test results and recommend such testing to physicians or for clients for planning purposes or modification of lifestyle.

Such counselors may work in a variety of clinical settings including pre-conception, prenatal, pediatrics, oncology, neurology, and other medical specialties, and they may be affiliated with academic medical centers, cancer centers and private practice settings.

To date, California; Hawaii; Illinois; Indiana; Massachusetts; New Jersey; New Mexico; Oklahoma; Tennessee, Utah and Washington have all enacted genetic counselor licensing laws.

CMS Releases Revised Guidance on EHR Rules

As promised at the Clinical Laboratory Improvement Advisory Committee (CLIAC) meeting last month, the Centers for Medicare and Medicaid Services (CMS) released revised interpretive guidance (Ref: S&C-10-12-CLIA) this week relating to the electronic exchange of laboratory information, and further identifying authorized individuals who may receive laboratory test results information. The guidance was issued by CMS’s Center for Medicaid and the State Operations/Survey and Certification Group.

The revision on electronic exchange of laboratory information offers interpretive guidance on surveying laboratories that use Health Information Technology (HIT) for the electronic exchange of laboratory information. The revisions focus on data to be included under existing retention requirement; additional considerations laboratories need to take into account with using HIT for the electronic exchange of laboratory information; and an explanation on how to manage corrected laboratory reports for an electronic health record.

The revision on authorized individuals offers interpretive guidance for the exchange of laboratory information by allowing laboratory results to be sent to the authorized individual and others designated by the authorized individual to receive the information.

The entire set of revisions went into effect on March 1, 2010.


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