On Tuesday, July 15, 2008, both the U.S. House and Senate voted to override the President’s veto of H.R. 6331, the “Medicare Improvements for Patients and Providers Act of 2008.” Thus ended the latest drama concerning Medicare payments to physicians which has waged on for several months and has become something of an annual ritual over the past several years. This year on July 1, a scheduled 10.6% pay cut to physicians went into effect because Congress failed to pass a law that would rescind it. The pay cut is the result of a complicated method of calculating the Medicare Conversion Factor based on the SGR (Sustainable Growth Rate) Formula, a system that most people agree is fatally flawed. The HHS Secretary put a temporary “hold” on this pay cut on June 27 for the first 10 business days of July, presumably in hopes that Congress would enact legislation to reverse the pay cut.

HR 6331 provides for a rescinding of the scheduled 10.6% Medicare Conversion Factor decrease retroactive to July 1 and a replacement with 0.5% update extension through December 31 and an additional 1.1% increase for calendar year 2009. This could have an immense effect on emergency physicians and emergency departments, particularly in the area of “access”. The payment cuts would have acted as a disincentive to provide ongoing primary and specialty care to seniors and the disabled. Had the pay cut gone into effect it is very likely that more patients would have come to the ED for routine care. The reversal also at least partially removes one of the barriers to referral of patients seen and treated in the ED and then referred to private physicians for follow-up.

The Bill also provides for several other positive changes for EPs. It lowers the copays for mental health services, which makes it more likely that seniors and the disabled will get adequate ongoing psychiatric care outside of the ED. It also provides coverage for some widely used anti-anxiety and sleep drugs not previously covered. The bill could make it easier and cheaper for new Medicare participants to get a physical check-up, which means that seniors may get more preventive and ongoing health care needs met outside of the ED. The law also allows physicians who “submit prescriptions electronically” to receive “an extra two percent.., in an effort to help reduce errors.”

This Bill doesn’t fix the SGR Formula problem, and it does not provide a permanent fix for physician payments for caring for Medicare beneficiaries. But it does expire in 18 months, which means that we’ll be seeing this drama again soon. Which means that every emergency physician should start now to lobby his or her congressmen and senators to work on a permanent fix. 

Michael Carius, MD, is a past president  of the American College of Emergency Physicians

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