Medicare Bill Passed The Senate

Wednesday, July 09, 2008

Dear Friends and Colleagues:

Good news! The U.S. Senate just passed HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, by a veto-proof majority of 69-30. Both Florida Senators, Sen. Martinez and Sen. Nelson, voted in favor of the bill.
As you know, the legislation replaces the 10.6% payment cut that went into effect on July 1 with a 0.5% update extension through December 31, 2008. For calendar year 2009, the update will be 1.1%. Other important provisions such as extending the GPCI floor on physician work were also included.
This success is due to the relentless pressure grassroots campaign lead by our American Medical Association and many others, including our county medical society. Our letter to Mel Martinez may have contributed to his change of opinion too We have to continue putting pressure on politicians who seem to represent the insurance industry but not the interests of their constituents. Don't forget that politicians want to get reelected!
The bill must now be signed into law by President Bush, who has signaled on more than one occasion that he intends to veto it. However, given the fact that the payment cuts have already occurred and that the bill passed both chambers with the two-third majority needed to override a veto, there is some reason to question next steps by the White House.
Our campaign has to continue and we have to flood the White House with calls and letters.
Again, thank you for your effort and support.
Together we are stronger.
Yours
Bernd

Bernd Wollschlaeger,MD, FAAFP,FASAM
President, Dade County Medical Association
AMA Delegate

Medicare Cuts

Congress failed to stop the 10.6% Medicare cut.

Dear Friends and Colleagues:
Unfortunately, by a vote of 58 to 40 the Senate failed to follow the example of the House and adopt H.R. 6331 - the “Medicare Improvements to Patients and Providers Act”
60 votes were needed to pass the bill. In a procedural move, the Senate Majority Leader Harry Reid (D-NV) changed his vote to "No" so that he could call the bill up at a future date. Therefore the measure fell one vote short of being adopted.
Lobbyist and representatives of our American Medical Association worked VERY hard to fight the looming Medicare cuts, but our elected officials voted against our interests.

Our AMA issued the following press release:

“The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America’s seniors, disabled and military families."

Comment:

U.S. Senator Mel Martinez voted AGAINST the bill, U.S. Senator Bill Nelson voted FOR the bill,.



“These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk because of the Senate's inability to act to stop drastic payment cuts for health care services that are needed by our Medicare and TRICARE patients


“The House voted to preserve access to care for Medicare patients in a bipartisan landslide vote to pass H.R. 6331 by an overwhelming margin of 355 to 59. The House made seniors, the disabled and military families a top priority. The AMA appreciates the courage of the 59 Senators, including nine Republicans, who voted to put patients ahead of partisan politics and vote for H.R. 6331.



“Today, thanks to some senators, we stand at the brink of a Medicare meltdown. On July 1 – just four days from now – the government will slash Medicare physician payments by 10.6 percent, forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.


"The Senate must return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue."


What can we do now?

* Call upon our Senators to return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue.
* Call Senator Bill Nelson to congratulate him for his courageous support of this bill Phone# 202 224-5274 or 305 536-5999.
* Call Senator Mel Martinez and advise him that his position has been duly noted and that we will inform our patients accordingly Phone#202 224-3041 or 305 444-8332
* Limit non-urgent Medicare appointments until congress acts and reverses the cut and inform our patients why we are forced to take those steps.
* Hand out information to our patients asking them to call their representatives to protest the looming drastic Medicare cuts
* Join your county, state and national medical association to support our efforts protecting your interests.

NOW is the time to act as a group! Our patients access to health care services is at stake and we have to stop private insurance companies from pocketing Medicare dollars.


Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association

Medicare Cuts and The Senate Vote Today

Dear Friends and Colleagues:

Today, Senate Bill 3101 "The Medicare Improvements for Patients and Providers Act " sponsored by Senator Baucus failed to gather enough support in the Senate for a closure vote.

It includes provisions to address serious, long-standing Medicare problems faced by millions of seniors on fixed incomes struggling every day with rapidly rising Medicare, food, and gasoline costs.
CBO (Congressional Budget Office) estimates that S. 3101 with that proposed amendment would increase spending on physicians’ and other services by $19.8 billion over the 2008-2013 period and
$62.8 billion over the 2008-2018 period; those amounts would be offset by reductions in payments to other providers (primarily Medicare Advantage plans). Taken together, the bill would reduce direct spending by $5 million over both the 2008-2013 and 2008-2018 periods, CBO estimates. S. 3101, when amended, would avert a reduction to Medicare’s physician fee schedule planned for July 1, 2008, by freezing those fees at their current levels for the remainder of the year and increasing them by 1.1 percent in January 2009. Beyond 2009, fees would be held at their current-law levels, necessitating a 21 percent reduction in 2010. The bill would also extend many expiring provisions of Medicare, expand Medicare’s coverage of preventive services, and modify the rules governing eligibility for the Medicare Savings Program. New spending under the bill would be offset largely by reductions in payments to and enrollment in Medicare Advantage plans. The bill, with the amendment, would phase out double payments for indirect medical education made to plans and hospitals for Medicare Advantage enrollees. It also would require private fee-for-service plans to adopt networks, with some exceptions, leading to decreases in enrollment and reduced outlays.

Senators who opposed the Baucus bill argued that the improvements for poor seniors were fiscally irresponsible, yet supported increased payments to physicians.
Those opposing SB 3101 support a legislation offered by Sen. Charles Grassley (R-IA).

Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians. Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.
The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.
Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.”

The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.

Comment:
Personally, I favor the Baucus plan but I am mindful and realistic that it would have been vetoed by President Bush and in the absence of a veto-proof majority would have died anyway.
Nevertheless, its failure demonstrates who are our friends and foes in the Senate.
From Florida Senator Martinez voted AGAINST the Baucus bill and we should send him a letter reminding him that Florida's seniors are a strong voting block and will exercise their right to vote in 2010 when his term will expire.
Let's remind our Senators that their attitude and position regarding Medicare reimbursement for physicians will be monitored by us!!

Yours truly,

Bernd
President,DCMA

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Grouped By Vote PositionYEAs ---54

Akaka (D-HI)Baucus (D-MT)Bayh (D-IN)Biden (D-DE)Bingaman (D-NM)Boxer (D-CA)Brown (D-OH)Byrd (D-WV)Cantwell (D-WA)Cardin (D-MD)Carper (D-DE)Casey (D-PA)Coleman (R-MN)Collins (R-ME)Conrad (D-ND)Dodd (D-CT)Dole (R-NC)Dorgan (D-ND)Durbin (D-IL)Feingold (D-WI)Feinstein (D-CA)Harkin (D-IA)Johnson (D-SD)Kerry (D-MA)Klobuchar (D-MN)Kohl (D-WI)Lautenberg (D-NJ)Leahy (D-VT)Levin (D-MI)Lieberman (ID-CT)Lincoln (D-AR)McCaskill (D-MO)Menendez (D-NJ)Mikulski (D-MD)Murkowski (R-AK)Murray (D-WA)Nelson (D-FL)Nelson (D-NE)Pryor (D-AR)Reed (D-RI)Roberts (R-KS)Rockefeller (D-WV)Salazar (D-CO)Sanders (I-VT)Schumer (D-NY)Smith (R-OR)Snowe (R-ME)Specter (R-PA)Stabenow (D-MI)Stevens (R-AK)Tester (D-MT)Webb (D-VA)Whitehouse (D-RI)Wyden (D-OR)

NAYs ---39

Alexander (R-TN)Allard (R-CO)Barrasso (R-WY)Bennett (R-UT)Bond (R-MO)Brownback (R-KS)Bunning (R-KY)Burr (R-NC)Chambliss (R-GA)Coburn (R-OK)Cochran (R-MS)Corker (R-TN)Cornyn (R-TX)Craig (R-ID)Crapo (R-ID)DeMint (R-SC)Domenici (R-NM)Ensign (R-NV)Enzi (R-WY)Graham (R-SC)Grassley (R-IA)Gregg (R-NH)Hagel (R-NE)Hatch (R-UT)Hutchison (R-TX)Inhofe (R-OK)Isakson (R-GA)Kyl (R-AZ)Lugar (R-IN)Martinez (R-FL)McConnell (R-KY)Reid (D-NV)Sessions (R-AL)Shelby (R-AL)Thune (R-SD)Vitter (R-LA)Voinovich (R-OH)Warner (R-VA)Wicker (R-MS)

Not Voting - 7
Clinton (D-NY)Inouye (D-HI)Kennedy (D-MA)Landrieu (D-LA)McCain (R-AZ)Obama (D-IL)Sununu (R-NH)

Medicaid Reform

Dear Friends and Colleagues:
Attached two letters to the editor published in the Miami Herald. The first by our very own Dr. Arthur Palamara cautions against the expansion of the Medicaid reform program into Miami-Dade County.His letter from April 22nd is a response to the letter from Representative Galvano published on April 19th.
I congratulate Dr. Palamara to his pointed response. We have to be careful to let ideology trump reason. Based on the best evidence the current Medicaid pilot program in Broward county has not met the expectations, or (less euphemistically) has failed.
We should not jump on the Medicaid reform bandwagon but review the results of the current pilot.
Further reform implementation should be based on facts and not wishful thinking. We need to solve the problem of Medicaid financing and protect healthcare for those in need.Our voices need to be heard and I encourage you to particiapte in the political debate.
Yours
Bernd

Posted on Tue, Apr. 22, 2008
Flaws in Medicaid
Re state Rep. Bill Galvano's April 19 letter, Expand Medicaid reforms: His assumptions of improved care for Medicaid patients are unsubstantiated. If anything, the contrary is true. Medicaid has regressed from a coordinated system of services to one that is highly fragmented, erecting innumerable obstacles for patients and providers.

Transfering healthier patients into for-profit HMOs leaves sicker and more-debilitated patients in the public-supported Provider Service Networks (PSNs).

Escalating costs suggest that neither of the two Broward Hospital District's PSNs will participate within a year.

While Medicaid reform may look good on paper, Broward's experience suggests that it does not function as designed. The Florida inspector general and the regulatory Agency for Health Care Administration recommend that the program not be expanded until additional data are accrued.

While the Legislature's desire to curb expense is appropriate, its parsimony should not be borne on the backs of Florida's most vulnerable patients.

ARTHUR E. PALAMARA, M.D., Hollywood
Posted on Sat, Apr. 19, 2008
Expand Medicaid reforms
More than 400,000 residents of Miami-Dade County depend on Medicaid. They have limited resources; many of them have serious, chronic disease or disabilities. They have no other source of healthcare coverage. They need and deserve our help -- not just more money, but better care and better results.

It is time to expand Medicaid reform to Miami-Dade because reform offers a better way. The current Medicaid system is flawed. Although Medicaid seems to offer an extensive menu of services, access is uncertain, coordination is random and outcomes are unknown.

Medicaid reform puts patients first. In current reform areas, participants have more plan choices. When they select a plan, they are choosing a unique set of benefits. Reform plans are offering new services -- the first time Medicaid ever expanded services without additional funding. Preventive dental care for adults and over-the-counter drugs are two of the most popular add-ons.

In the second year of reform, four plans expanded the extras and four more added benefits. Reform plans also reduced patient cost-sharing. Reform offers incentives for healthy behaviors. The key to making Medicaid serve patients better is to make the patients themselves the bellwether of success.

To bring state spending back within bounds, Medicaid funding -- now 27 percent of Florida's budget -- must be reduced. We can cut eligibility, eliminate services or reduce prices. Medicaid reform offers a better way by providing incentives for innovations that deliver services more efficiently and effectively and the tools to manage Medicaid in a way that best serves both patients and taxpayers.

REP. BILL GALVANO, chair, state House Committee on Healthy Families, Bradenton

Mental Health Parity

Dear Friends and Colleagues:
Representative Ed Homan (R-Tampa) has been tirelessly working on a Mental Health Parity Bill.
Today, it passed with 18-Yeas and )-Nays the Healthcare Council.
House Bill 19 amends s. 627.6688, F.S., to add substance-related disorders to the mandated offering required
by that section. The bill repeals s. 627.669, F.S., which imposes a mandated offering for substance abuse
services. The bill further amends s. 627.6688, F.S., to specifically define those mental health conditions that
must be covered within the mandated offering, generally including all diagnostic categories of mental health
conditions listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders and as
listed in the mental and behavioral disorders section of the current International Classification of Diseases.
The bill deletes current law limiting mental health benefits by specific service areas, such as inpatient benefits,
and inserts a general statement that the mental health benefits may not be more restrictive than the treatment
limitations and cost-sharing requirements that are applicable to other diseases, illnesses, and medical
conditions.
The bill mandates that the parity requirements be separately applied to each benefit package offered by an
employer.
The bill would have an indeterminate negative fiscal impact on the State Employees’ Group Health Self-
Insurance Trust Fund.
The effective date of the bill is January 1, 2009.
For more detailed information please visit http://edhoman.com/public/parity.html


Bill Number: 0019
Bill Name: HB 19
Action: Favorable With Council Substitute
Committee: Healthcare Council
Location: Morris Hall (17 HOB)
Duration: 3.50
Date: 4/8/2008 8:30:00 AM
Sponsor: Homan (CO-SPONSORS) Anderson; Brandenburg; Brisé; ...
Subject: Coverage for Mental, Nervous, and Substance-relate...


Y Anderson Y Galvano Y Harrell Y Patronis Y Schwartz
Y Ausley Y Garcia, R. Y Hays Y Porth Y Skidmore
Y Bean Y Gibson, H. Y Hooper Y Roberson Y Zapata
Y Cusack Y Grimsley Y Hudson

Total Yeas: 18 Total Nays: 0 Total Missed: 0 Total Votes: 18

Please contact your legislator to thank them for their support and encourage them to move this bill forward for final passage.
Also contact Rep. Ed Homan to express your support for his efforts and contribute to his campaign.
Yours
Bernd

OUR AMA IS THE VOICE FOR THE UNINSURED

Dear Friends and Colleagues:
Massive healthcare cuts on state level will further increase the number of Americans without health insurance. Now, the burden has fallen to cities and counties to tackle the growing problem that prevents millions of people from getting timely medical care.In Dade County almost 30% of all residents lack healthinsurance coverage. As a physician and citizen I will not remain silent! In my practice almost ALL of my patient have no health insurance and the number is growing every day. I am seeing more patients every day and many of my clients represent hardworking and lawabiding men and women. They desperately try to make a living amidst sharply increasing costs for food, mortgage, utilities and gas. They do not qualify for Medicaid but can't afford health insurance. They often ask me," Who speaks up for me?"
Now we can proudly answer that OUR AMA is stepping up to the challenge and has released a Health Insurance Reform proposal that can truly address the problem. As an AMA Delegate I have started to speak about the plan and just today spoke at a meeting of a local Democratic Party Club.
Most have never heard about the plan. The questions after the presentations reflect great interest and cautious support.
I encourage each of you to read about the proposal (http://www.ama-assn.org/ama/pub/category/17712.html) which hinges on three elements: 1) Tax credits instead of tax exclusion and subsidy for the high federal income tax brackets, 2) Individually Selected and Owned Health Insurance, 3) Development of New Health Insurance Markets.
Consumer choice is the cornerstone of the AMA's proposal to expand coverage. The AMA plan would limit the role of government to those who cannot afford any insurance, avoiding a one-size-fits-all approach.
The plan is not be perfect but can serve as a platform for discussion and can be amended or expanded.
I am developing a power point presentation about the proposal for the lay audience and am happy to share it with any of you.
As AMA members we should all engage in informing our patients, our families and legislators about this proposal.
Now is NOT the time to question if we have a problem with uninsured Americans but to focus on how to resolve the problem.
Our FMA should be an active partner in this campaign and not stand on the sidelines questioning the validity of the number of uninsured. Realism is the only -ism we should pursue. Our contribution to solve this problem will promote our public image!
I am carrying the message to community groups, the chambers of commerce and to anyone who wants to listen and debate the issue on a rational basis.
Now its your turn! Join us in this campaign!
Yours
Bernd

FOR MORE INFORMATION SEE:

* http://www.ama-assn.org/ama/pub/category/18351.html
* http://www.ama-assn.org/ama/pub/category/17712.html
* http://jama.ama-assn.org/cgi/content/full/291/18/2237

Physicians Ranking

"The Patient Charter drafted by the Consumer-Purchaser Disclosure Project requires health insurers to be more transparent and balanced when providing information to patients. These crucial principles offer hope that patients will be able to trust the information to make informed health care choices. Safeguards must ensure that physician rating information does not result in reduced access to care or disrupt patients' longstanding relationships with their physicians.Efforts by health insurers to rate physicians must not be driven solely by costs and economics. The primary goal of these programs must be to promote quality care using meaningful measures. The AMA has long been involved in these efforts through the Physician Consortium for Performance Improvement and National Quality Forum."


Dear Friends and Colleagues;

Attached you find a recent press release from the AMA regarding the Consumer-Purchaser Disclosure Project.
In this press release the AMA supports the coalition's call for transparency and accurate reporting among health insurers
I applaud our AMA to take this proactive approach and to call for an opening of the insurance companies physician rating programs for careful evaluation to assess accuracy, integrity and fairness.
As physicians we need to collaborate on establishing an accurate and transparent quality measurement and reporting system that provide our patients with an objective yardstick to measure and rank their physicians performance.

Yours
Bernd
AMA Delegate
==============================================================================================================
For immediate release
April 1, 2008

Statement attributed to:
Nancy Nielsen, MD
AMA President elect

"The American Medical Association applauds efforts by the Consumer-Purchaser Disclosure Project to raise the bar on the reliability and validity of information that health insurers provide to patients.

"The Patient Charter drafted by the Consumer-Purchaser Disclosure Project requires health insurers to be more transparent and balanced when providing information to patients. These crucial principles offer hope that patients will be able to trust the information to make informed health care choices. Safeguards must ensure that physician rating information does not result in reduced access to care or disrupt patients' longstanding relationships with their physicians.

"Efforts by health insurers to rate physicians must not be driven solely by costs and economics. The primary goal of these programs must be to promote quality care using meaningful measures. The AMA has long been involved in these efforts through the Physician Consortium for Performance Improvement and National Quality Forum.

"Instead of tiered and narrow networks, the AMA believes that providing valid data to physicians and patients will better improve the quality and efficiency of care.

"The work of the Consumer-Purchaser Disclosure Project reinforces the need to protect access to care and the patient-physician relationship by requiring insurers to open their physician rating programs for careful evaluation to assess accuracy, integrity and fairness.

"Although additional work must be done to accurately and fairly evaluate the individual work of physicians, the AMA sees the Patient Charter as an important step in the right direction and we offer our assistance in ensuring its criteria are appropriate and measurable."

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