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Window is closing on Congress' ability to address Medicare cuts
July 03, 2008 | By Mary Garrigan, Rapid City Journal

A temporary 15-day freeze on Medicare payments to doctors won't hurt providers or affect medical care in western South Dakota yet, but it sends a powerful message to Congress to address a pending 10.6 percent cut in Medicare physician payments soon, Regional Health System chief Dr. Charles Hart said Thursday.

On June 27, the Senate failed, by two votes, to pass a Medicare improvement act that sailed through the House of Representatives earlier in the week by a veto-proof margin. HR6331 would stop the Bush Administration's plan to enact cuts in Medicare payments to doctors. The unpopular cuts were supposed to take effect in December 2007, but Congress delayed them until July 1 to give itself time to pass a legislative fix, something that has become a yearly event. In the past five years, Congress has blocked the cuts four times.

Now that the July 1 deadline has come and gone, the Centers for Medicare and Medicaid Services said it would not process any physician claims at the new, lower reimbursement rates until July 15, essentially giving Congress another week to address the issue.

Hart and Rep. Stephanie Herseth Sandlin, D-S.D., who visited Rapid City Regional Hospital on Thursday, agreed the Medicare cuts would be disastrous for western South Dakota physicians and their patients. Both said the 15-day freeze by the Centers for Medicare and Medicaid Services only highlights the importance of the Senate addressing the issue when it returns next week.

"A 10.6 percent cut ... would not only affect Medicare patients, but it would affect patient care throughout all of central and western South Dakota," Herseth Sandlin said.

Nationwide, more than half of all doctors have said the cuts would force them to cut some staff and services, and 14 percent said they would quit patient care altogether if the cuts are enacted.

"Time is really working against us at this point, because we only have about seven weeks of session left before the election," Herseth Sandlin said. She blamed Republicans for the Senate impasse, saying some of her colleagues are more interested in protecting the profits of Medicare Advantage plan providers than in ensuring access to primary health care in rural areas.

Sen. Tim Johnson, D-S.D., voted to advance the legislation; Sen. John Thune, R-S.D., was one of 40 senators who voted against it.

A spokesman for Thune said the senator strongly supports ensuring that doctors receive fair payments for treating patients enrolled in Medicare. He would have voted for HR6331 if that were the only issue it dealt with.

The 280-page law is complex, especially concerning the Medicare Advantage plans that seem to be the line in the sand drawn over Medicare reform this year. Those plans, enrollments in which are rising rapidly nationwide, are seen as a trend toward privatizing Medicare. Medical Advantage plans benefit from slightly higher reimbursement rates than traditional Medicare does, so those plans can offer their beneficiaries a few more benefits.

Thune's office said there are 11,000 seniors enrolled in Medicare Advantage plans in the state and that HR6331 would eliminate the chosen plan for about 2,400 of them as well as increase out-of-pocket expenses for others. The Kaiser Family Foundation Web site says 4,863 South Dakotans were enrolled in Medicare Advantage plans in 2007.

Thune favors Senate Bill 2785, the Save Medicare Act, which would provide an 18-month physician fee fix. He also supports a 30-day extension of the current law to give the Senate more time for an agreement while not jeopardizing physician payments.

Herseth Sandlin contends the bill makes modest reforms to private, fee-for-service Medicare Advantage plans, not the HMO and PPO plans that are more common in South Dakota.

Those reforms would save an expected $12 billion over five years.

"These are common-sense reforms that are better for providers in rural America and also better for the long-term solvency of traditional Medicare, based on the bonus payments and overpayments that have gone to some of the fee-for-service private Medicare Advantage plans," she said.

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