College of American Pathologists
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December 10, 2009  •  Volume 25, Number 25
Next Issue: December 23, 2009
© 2009 College of American Pathologists

In This Issue:

For Senate Democrats, It’s Beginning to Look A Lot Like Christmas
Lobbying Funds Still Fuel the Debates
Physicians Report Problems with PECOS Database Registration

For Senate Democrats, It’s Beginning to Look A Lot
Like Christmas

With the Christmas holiday looming, Senate Majority Leader Harry Reid (D-NV) has shown just how determined he is to pass a healthcare bill before the New Year. Partisan amendments are slowing the legislative process to a crawl and controversial issues like abortion and the public insurance option are fueling differences between different Democratic factions, and yet, progress is being made.

To help resolve these differences and move the process along, the Majority Leader assigned a group of five liberal and five moderate Senate Democrats to work out a compromise on the public insurance option that would produce the 60 needed votes to end debate on the bill and set the stage for final passage. As of late Tuesday, it appeared the group had reached some consensus (although no details were provided) and forwarded new provisions to the Congressional Budget Office for analysis.

The group includes Senators Sherrod Brown (D-OH), Thomas Carper (D-DE), Russ Feingold (D-WI), Tom Harkin (D-IA), Mary Landrieu (D-LA), Blanche Lincoln (D-AR), Ben Nelson (D-NE), Mark Pryor (D-AR), John D. Rockefeller IV (D-WV), and Charles Schumer (D-NY).

According to reports, the group reached agreement on a public option alternative that would establish a network of not-for-profit insurance plans organized by the federal Office of Personnel Management, which runs the Federal Employees Health Benefits Program, to compete with traditional insurance plans in insurance exchanges. While not a public option, it would allow the federal government more control over insurance practices.

In return for concession on this issue, liberal senators sought to expand the Medicare program by allowing people between 55 and 65 years old to “buy-in” to Medicare if they cannot find coverage elsewhere. A companion proposal would raise the income ceiling for Medicaid benefits from 133 percent of the poverty level to 150%. The current poverty level is about $22,000 for a family of four. The American Medical Association, still focused on replacing the Medicare physician payment formula, said it would oppose any expansion of Medicare until the program’s financial outlook improves.

Impact on Physician Payment in the New Year

If the Senate fails to pass a bill, and if Congress fails to step in and pass legislation to override it, pathologists and all physicians will face an immediate 21.5% cut in Medicare payments due to an automatic reset of the Sustainable Growth Rate (SGR) formula on January 1, 2010. In addition, the TC-Grandfather will expire.

House members this week are working on legislation to provide a 30-day bridge on the SGR, and CAP is actively pursuing a similar continuance for the TC-Grandfather.

While the scenario of a temporary expiration of either provision would create administrative problems for pathologists, CAP is advising its members to hold off on taking any action until Congress has an opportunity to correct the problem. Statline will report more on this concern in the next issue.

Amendments Slow the Process

Congressional observers who expected an abundance of amendments to be offered have not been disappointed. Many are unlikely to pass, but must be debated and considered none-the-less. Here’s a sampling:

  • Eleven freshmen Democratic senators led by Sen. Mark R. Warner (D-VA) unveiled a bundle of amendments dubbed the “Value and Innovation Package”, intended to control costs, reduce fraud, improve transparency, and encourage innovation.

    The bundle contains over 20 provisions, including measures to possibly extend and expand the national pilot program on payment bundling; require the proposed Center for Medicare and Medicaid Innovation to link to models used in the private sector; permit physicians who report quality data through a qualifying Maintenance of Certification (MOC) program to be eligible for an incentive payment for years 2011-2014. Visit Senator Mark Warner’s website to see all of the amendments proposed by the freshmen Senators.

  • Senators also spent several days debating public funding for abortions before voting to table Sen. Ben Nelson’s amendment to ensure that no federal funds would be used to pay for abortions. Like the legislation approved in the House bill, it would have prohibited the use of affordability tax credits to purchase a health insurance policy that covers abortion, and prohibited federal funding for abortions under the community health insurance option. Tabling amendments permits the Senate to review other amendments without completely killing the amendment previously debated.

  • Another proposal, introduced by Senator Byron Dorgan (D-ND), would allow the importation of cheaper prescription drugs, a move that could rouse the ire of the powerful pharmaceutical industry.

It remains unclear how the Freshman Senators’ package and the Dorgan amendment will ultimately be resolved, although most insiders believe compromises will be reached and the Senate will, in the end, pass a healthcare bill.

However, the clock is winding down on 2009, and it is looking increasingly possible that the bill will not be passed and signed into law by December 31.

CAP will continue to closely follow the bill’s progress and keep members informed as events unfold.

Comment On This Article

Lobbying Funds Still Fuel the Debates

With so much at stake in the healthcare reform debate, it is little wonder the Health sector topped the list of industries spending the most on lobbying this year.

In its third quarter report on 2009 federal lobbying expenditures, and the Center for Responsive Politics estimated that corporations, unions, trade associations, and other special interests spent $849 million in federal lobbying during the last quarter, and over 30% of that was spent on the healthcare debate.

Misc. Business$362,259,396
Finance, Insurance & Real Estate$334,341,984
Energy & Natural Resources$300,512,509
Lawyers & Lobbyists$24,617,969

Of this, spending by pharmaceutical and health product companies dwarfed the other industries in the sector, spending more than double and triple the others.

2009 Y-T-D Health Sector Expenditures by Industry
IndustryTotal Spending
Pharmaceuticals/Health Products$199,323,702
Hospitals/Nursing Homes$77,465,842
Health Professionals$59,328,887
Health Services/HMOs$52,834,453
Misc Health$7,287,971

While these numbers are informative, they tell only part of the story. They will not determine who the winners and losers will be. Nor with they shed any light on key aspects of the reform. However, they do provide interesting insight into the interest in this issue from throughout the healthcare continuum.

Data and tables provided by

Comment On This Article

Physicians Report Problems with PECOS
Database Registration

The last issue of Statline reported CMS will delay until April 5, 2010 enforcement of its Change Requests 6417, requiring all physicians to register in Medicare’s “Provider Enrollment, Chain, and Ownership System” (PECOS).

While this is welcome news, which came at the urging of CAP, the American Medical Association and other physician groups, a substantial number of physicians are reporting having difficulty determining through their contractor if they are already registered in the PECOS system, and if they are not registered, some are experiencing significant delays in registering.

According to CMS, if a physician is not in PECOS, their contractor should look for their names in other contractor files. If a physician tries to voluntarily enroll and the contractor turns them away (i.e., informs them to wait for a revalidation letter) the physician should report this to CMS.

AMA has posted information on how to reenroll. Visit the AMA website, then select “Medicare Enrollment”. Or, visit the CMS Pecos website for Medicare Enrollment

Comment On This Article


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