Medicare physician reimbursement
For Medicare physician reimbursement, it is indeed the eleventh hour. House and Senate conferees are considering a compromise bill that would raise physician reimbursement by 1% in 2006, against the scheduled 4.4% decrease that is slated to go into effect if no action is taken. This decrease was part of previous Medicare and budget bills, and allowed Congress and the Administration to claim lower costs for Medicare programs when these bills were originally passed. Now, Congress, faced with a vocal and engaged physician community, is forced to either increase reimbursement or deal with the fallout from physicians dropping out of Medicare.
The AMA is quite active in this, lobbying everyone with a pulse on Capitol Hill in an effort to get the increase passed and kill a proposed pay-for-performance initiative.
According to the Washington Post, "Congress is considering a pay-for-performance proposal that in 2007 would cut 2% of Medicare reimbursements if a physician did not report quality data to the federal government…"
The conferees arguing about these provisions are Republicans; Democrats have essentially been shut out of the process. While this may be politically expedient, it is my sense that the GOP legislators may have painted themselves into a corner. Without Democrats participating in the process, Republicans have forced themselves into a Hobbesian choice - anger the physician community or raise Medicare costs. Either way there is no political cover - the Democrats can't be blamed.
Note - as Medicare's fee schedule is used in many states for workers comp and auto reimbursement rates, and by health plans as the basis for their reimbursement as well. There will indeed be unintended consequences for many payers. And few of the property and casualty insurers are paying any attention.
What does this mean for you?
Physician reimbursement will likely be increased and so will fee schedules.