Threatened Medicare Cut Turns Into Slight Boost

A dramatic Congressional vote last month that ended the 40-year-long discriminatory copayment for Medicare beneficiaries seeking outpatient psychiatric services (see Congress Ends Medicare's Mental Health Copay Bias) also averted a 10.6 percent across-the-board cut in Medicare payment to physicians that was to have gone into effect July 1.

The Medicare Improvements for Patients and Providers Act (HR 6331) defers the 10.6 percent cut in the Medicare payment update until January 1, 2010, and provides an average 0.5 percent increase for the remainder of 2008. It would also provide a 1.1 percent increase for 2009.

In addition, the act provides a temporary bump in payments for psychotherapy services.

“While cautioning that we are still reviewing the practical consequences of all of these factors, we believe that they will result in a meaningful increase in Medicare payments for at least some, and perhaps many, APA members,” said Nicholas Meyers, director of the APA Department of Government Relations, in a statement following passage of the bill.

The bill was originally passed in dramatic fashion as Senator Edward Kennedy (D-Mass.) cast a crucial vote in his first appearance on the Senate floor since being diagnosed with brain cancer.

“As soon as Senator Kennedy assured the win, nine additional Republicans switched their votes from 'no' to 'yes,' joining their nine GOP colleagues who had again voted for passage, giving the bill two more votes than the 67 needed to assure a veto-proof margin of victory,” Meyers said. “The nine additional Republicans are Senators Alexander (Tenn.), Corker (Tenn.), Cornyn (Texas), Hutchison (Texas), Chambless (Ga.), Isakson (Ga.), Martinez (Fla.), Specter (Pa.), and Warner (Va.).”

They joined Republican Senators Collins (Maine), Snowe (Maine), Coleman (Minn.), Dole (N.C.), Murkowski (Alaska), Stevens (Alaska), Roberts (Kan.), Smith (Ore.), and Voinovich (Ohio), who had voted in favor of HR 6331 in the original vote prior to the July 4 recess, Meyers noted.

President Bush vetoed the bill several days after it was passed, but his veto was overridden by a 483-41 vote in the House and a 70-26 vote in the Senate.

Passage of the bill in the Senate came after an intense campaign by the AMA and other physician organizations, including APA, in which the groups expressed their outrage when the Senate failed to pass the same Medicare bill just before the July 4 recess.

Commenting on that earlier failure to pass the bill, AMA President-elect J. James Rohack, M.D., said, “On July 1, a Medicare physician payment cut of 10.6 percent went into effect, putting access to health care for seniors, the disabled, and military families at risk.” But, he noted, that sparked “tens of thousands of patients and physicians to contact their senators and urge them to vote for HR 6331. Those voices were heard and heeded.”

The July 1 date for the scheduled payment cut was the result of an 11th-hour compromise reached on December 18, 2007, just days before the congressional Christmas break, in which the Senate Finance Committee approved a 0.5 percent increase in overall physician Medicare payment to last until June 30. That small increase was a six-month reprieve from an impending 10.1 percent overall cut originally proposed by the Centers for Medicare and Medicaid Services (Psychiatric News, January 18, 2008).

The text of HR 6331 can be accessed at<http://thomas.loc.gov> by searching on the bill number. ▪