Medicare Legislation Becomes Law
July 2008
On July 15, President Bush's veto of H.R. 6331, the Medicare Improvement for Patients and Physicians Act of 2008, was overridden by a strong bipartisan vote in the House and Senate. H.R. 6331 now becomes law and drastic cuts in Medicare physician payments are averted for the remainder of 2008 and in 2009.
The legislation picked up the support of additional Republicans in both chambers. The final vote tally was 383-41 in the House and 70-26 in the Senate.
Click here to find out how your lawmakers voted.
Thanks to the STS members who made repeated calls to their House and Senate lawmakers urging support of H.R. 6331. Physicians across the country flexed their political muscle and secured one of the most significant legislative victories in recent history.
In a few weeks, lawmakers will be back home in their states and districts for the August congressional recess. You are encouraged to look for opportunities to thank lawmakers who voted to help physicians and ensure that Medicare beneficiaries continue to have continued timely access to cardiothoracic surgery services. At the same time, this represents a good opportunity to remind your legislators that physician reimbursement under Medicare represents a longer-term problem that simply must be fixed, for the benefit of patients and our national interest.
Click here for more information on the Medicare physicians fee schedule payment rates.
Please watch for a detailed report of H.R. 6331 in the next edition of STS Beltway Briefings that will be sent to you by e-mail.
Senate Passes Medicare Legislation 69-30
July 2008
On July 9, the Senate passed the "Medicare Improvement for Patients and Physicians Act of 2008" (H.R. 6331) by a veto-proof vote of 69-30. The strong vote in the Senate came less than two weeks after a Republican filibuster on the same bill and after a massive nationwide grassroots campaign by physicians. In the end, your calls and e-mails made all the difference.
Eighteen Republicans voted with Democrats in support of the bill. The only senator not voting was Sen. John McCain (R-AZ). The following Republicans voted to support the bill:
Alexander (R-TN), Chambliss (R-GA), Coleman (R-MN), Collins (R-ME), Corker (R-TN), Cornyn (R-TX), Dole (R-NC), Hutchison (R-TX), Isakson (R-GA), Martinez (R-FL), Murkowski (R-AK), Roberts (R-KS), Smith (R-OR), Snowe (R-ME), Specter (R-PA), Stevens (R-AK), Voinovich (R-OH), Warner (R-VA)
The strong vote in the Senate was unquestionably bolstered by the return of Sen. Edward Kennedy (D-MA) to Capitol Hill who interrupted his cancer treatment to cast his vote.
H.R. 6331 will continue the 0.5 percent update in Medicare physician payments through 2008 and will provide a 1.1 percent update in 2009. The positive payment update will be retroactive to July 1. The legislation also continues and enhances the Physician Quality Reporting Initiative (PQRI) through 2010.
The legislation now heads to the President for his signature. A veto threat by President Bush still looms.
H.R. 6331 Fails Senate Vote
Medicare Payment Cuts Take Effect on July 1
June 2008
In a disappointing turn of events, the Senate failed by one vote to end a filibuster on H.R. 6331, the "Medicare Improvement for Patients and Providers Act of 2008." Failed action in the Senate came just two days after House passage of H.R. 6331 by an overwhelmingly bipartisan vote.
The failure of the Senate to advance H.R. 6331 means that the 10.6 percent cut in Medicare physician payments will take effect as scheduled on July 1. Any further action on a Medicare bill will have to wait until Congress returns from its week-long July 4 recess.
Sixty votes are needed to end a filibuster. In the end, nine Republicans crossed the aisle to vote with Democrats in favor of H.R. 6331. Those senators were: Sens. Dole (R-NC), Snowe (R-ME), Smith (R-OR), Roberts (R-KS), Coleman (R-MN), Collins (R-ME), Stevens (R-AK), Voinovich (R-OH), and Murkowski (R-AK).
The official recorded vote was 58-40. Not voting were Sens. Edward Kennedy (D-MA) and John McCain (R-AZ). Please note that Majority Leader Harry Reid (D-NV) voted "yes" but then changed his vote to "no", a procedural tactic that allows him to bring H.R. 6331 back to the floor for reconsideration.
Members of Congress take Action to Address Impending Physician Medicare Cuts
March 2008
Two more Medicare payment cuts, totaling more than 16%, are scheduled for this year if Congress does not step in and take action to prevent them. In the U.S. House of Representatives, Congressmen Mark Kirk (R-IL) and Bart Gordon (D-TN) are taking the lead and asking their colleagues to sign on to a letter to Committee Chairmen and Ranking Republicans urging action to prevent the cuts early on to help stabilize the Medicare system. In the U.S. Senate, Senator Debbie Stabenow introduced S. 2785, the Save the Medicare Act of 2008.
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STS Advocates for Medicare Bill with New Radio Ad
August 2007
After long and heated debates in the U.S. House Ways and Means and Energy and Commerce Committees, the Children's Health and Medicare Protection (CHAMP) Act, which would expand children's health insurance and prevent Medicare Physician payment cuts, comes to the House floor this week. The Senate bill, which passed through the Senate Finance Committee with relative ease and only addresses children's health insurance, is also due on the Senate floor before the August recess.
While there are indeed issues of concern, the CHAMP Act is the best chance we have to prevent the 10 percent Medicare cut and repeal the Sustainable Growth Rate (SGR). Though it is likely to be whittled down through Senate negotiations, veto threats, and at other points in the process, STS has written a strong and unqualified endorsement letter.
To support passage of the bill, STS has taken the lead and helped organize a paid media campaign with other medical and dental specialty groups, targeting members of Congress who are on the fence in their support of the CHAMP Act. The radio advertisement asks constituents to contact these members of Congress and urge their support for this legislation on the House floor this week. The ads will run in each district between Monday and Thursday of this week. Click here [MP3] to hear the radio advertisement.
If the legislation is passed this week, the House and Senate will meet in September in "conference committee" to resolve the differences in the two bills. The Senate will be the key as to which level doctors will be paid under Medicare next year and beyond. We need everyone to contact their Senators (particularly those on the Finance Committee) during August and urge they act now to prevent the 10 percent payment reduction, paid for with tobacco tax and HMO overpayment reductions.
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CMS Announces New Medicare Values for CT Surgery Procedures
November 2006
The Society of Thoracic Surgeons' multi-year effort to achieve more accurate values for cardiothoracic surgery procedures has paid off! CMS has now reversed its proposed rule and accepted the RUC-recommended, higher and more appropriate values for 72 adult cardiac and general thoracic procedures for Medicare in 2007 and beyond.
Beginning in 2004, the STS/AATS Joint Workforce on Nomenclature and Coding began preparing for the Medicare Relative Value Update Committee (RUC) Five Year Review as an opportunity to improve the accuracy of values for cardiothoracic surgery codes.
In a departure from previously used methodologies, the Joint Workforce, under the leadership of Workforce Chair Peter K. Smith, set out to use data from the STS National Cardiac Database to more accurately capture time and acuity data for the procedures most commonly performed by CT surgeons. This new methodology was a subject of great debate both at the RUC and at CMS, and was ultimately approved by the RUC. (See STS News, Fall 2006, Vol. 12, No. 4, page 5.)
CMS, in its proposed physician payment rule of June 29, rejected the new STS-derived values, and proposed instead, mostly lower values with skewed relativity between procedures. STS/AATS comments in response to this rejection were extensive and powerful. In a stunning reversal of its proposed rule, CMS on Wednesday night, November 1, accepted the RUC recommended work relative values for our procedures.
In the final rule, CMS states:
"We appreciate the detailed information provided by the commenters in response to the concerns we had outlined in the June 29, 2006 proposed notice. Based upon a review of the specific information provided by the commenters concerning the STS database, as well as the information provided specifically addressing the use of the mean values for the intra-service time and methodology used to estimate IWPUT, we will accept the RUC-recommended work RVUs for these services."
Regarding the use of the STS data, the CMS Final Rule stated, "We believe the STS database represents a significant advance in the effort to improve the quality of patient care and we hope that this kind of data collection will be emulated by other specialties."
Other highlights from the Final Rule include:
* An increase in total relative value of 13%, composed of an increase in the work units by 23% and a decrease in practice expense by 2%.
* For Medicare patients, there will be an internal negative adjustment to achieve budget neutrality that will still result in an increase in Medicare payment of 6%.
* For the complete list of CT procedure codes reviewed and their estimated impact with and without the SGR reduction, please click here.
* Please click on the links to read just the CT relevant sections of the CMS proposed and final rules.
* Please click on the links to read the entire text of the CMS proposed physician fee schedule rule and for the final rule.
We are still at risk for the scheduled negative update to the Medicare conversion factor, which if not remedied by Congressional action, will neutralize our scheduled payment increase for the care of Medicare beneficiaries.
The impact of the Final Rule (over 1,400 pages in length) is being intensively analyzed by the Workforce. A detailed report to the membership will be forthcoming in the coming week.
I am very pleased to report such excellent news. On behalf of STS, I will take this opportunity to commend CMS on its willingness to consider and accept a new methodology as well as its recognition of the inherent value of quality data sources such as the STS National Databases. I also extend thanks to all the STS members and volunteer leaders who participated in the RUC process and contributed to this success.
Frederick L. Grover, MD
President
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STS Fights for Fair Medicare Payment: STS-AATS Respond to Government on Proposed Valuations for 2007. 
The Centers for Medicare and Medicaid Services have issued the proposed rule to establish Medicare fee schedule payments for 2006 and beyond. In addition to a 4.4% payment reduction due to SGR, the agency proposes several methodological changes to practice-expense calculations. The changes will result in additional reductions to the specialty due to increases in others? practice-expense payments. These additional reductions could range from 3% to 15%.
In a comment letter to CMS Administrator Mark McClellan, STS President Sidney Levitsky and AATS President Richard Jonas convey to CMS in the strongest of terms why this must not go forward. Both organizations also reiterate the damage caused to the cardiothoracic surgery specialty by previous CMS policies. Please click on the link below to read the letter to CMS.
AATS-STS Letter to CMS (9-30-05)
Legislation has been introduced in Congress that would prevent scheduled Medicare physician payment cuts and enact reimbursement INCREASES in 2006 and 2007!
Please click here to urge your elected representatives to support H.R. 2356 and S. 1081.
The charts listed below reflect the future payment rates for CABG and Lobectomy if STS members do not act today to prevent reductions:
