Medicare Modifications

The Hospitalist. 2008 December;2008(12):

December 1, 2008|The Hospitalist

Most hospitalists vividly recall Congress overriding President Bush’s July veto to avert a hefty, 10.6% cut in Medicare Part B payments to physicians. That memorable, last-minute save (instead of a pay cut, Congress increased Part B payments by 1.1%) was just a tiny part of some important legislation. The Medicare Improvements for Patients and Providers Act (MIPPA) includes myriad provisions addressing Medicare benefits, protections for low-income beneficiaries, changes for providers, data collection requirements for correcting healthcare disparities, and much more.

Hospitalists will be particularly interested in a handful of the provisions outlined in MIPPA, some of which impact them directly and others that will affect hospitals and clinical care, and still more whose outcomes remain to be seen.

Public Policy Points

Federal Help for Primary Care Physician Shortage

A House bill introduced this fall is designed to help reverse the growing shortage of primary care physicians. The Preserving Patient Access to Primary Care Act (H.R. 7192), introduced by Rep. Allyson Schwartz (D-Pa.), would require a study to recommend the designation of primary care as a shortage profession; provide recruitment and retention incentives through grants, scholarships, and loan forgiveness; encourage medical students to choose careers in primary care; establish measures to support and expand the patient centered medical home (PCMH) model of care; and proposes comprehensive reforms of payment systems under Medicare, to support, sustain, and enhance the practice of primary care.

Public Health Program Funding on Hold

Legislation providing money to the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) has been postponed until 2009 in order to avoid a veto by President Bush. Bush threatened to veto domestic spending bills that exceed his FY 2009 budget request, so Democratic leaders have decided to wait to finish the appropriations bills until President-elect Barack Obama takes office. The House Labor-HHS-Education Appropriations subcommittee provided $375 million for AHRQ in its FY 2009 appropriations bill, which is an increase of $41 million over FY 2008, compared to the Senate Appropriations Committee, which would only fund AHRQ at current spending levels.

Hawaii Drops Universal Healthcare for Children

Just seven months after the 50th state implemented Keiki Care, a universal health care program for children, the state has stopped the program. As of November, the state discontinued funding for 2,000 children enrolled in the program, but Hawaii Medical Service Association (HMSA) will cover the children through the end of 2008 and families are being encouraged to apply for Medicaid coverage or enroll in the HMSA Children's Plan. According to Gov. Linda Lingle, the program was stopped because of a state budget shortfall. Hawaii faces a projected $900 million general fund deficit by 2011.

For example, MIPPA is the legislation that extends the Physician Quality Reporting Initiative (PQRI) for two years, offering a bonus payment in 2009 and 2010 of 2% (up from 1.5%) of total Medicare allowed charges. It also directs the Centers for Medicare and Medicaid Services (CMS) to publicly post the list of providers who participate in the PQRI. (See “A Permanent PQRI” in the October 2008 issue of The Hospitalist.)

MIPPA also requires CMS to establish a program to promote widespread adoption of electronic prescribing, as outlined in “e-Prescription for Success?” in the September 2008 issue of The Hospitalist. Reporting on e-prescribing is not likely to apply to hospitalists, says Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee. “Of course, it depends on whether the hospital uses it, but no one can say whether a hospitalist will get a benefit for reporting on e-prescribing,” he says.