May 9, 2008

1. APDIM Members Speak Against Cuts to Medicaid GME on Capitol Hill

2. Administration Sets Deadline for Congress to Delay Physician Pay Cut

1. APDIM Members Speak Against Cuts to Medicaid GME on Capitol Hill

The Association of Program Directors in Internal Medicine (APDIM) held its annual Hill Day, Wednesday, May 7, 2008, to encourage members of Congress to support the extension of the one-year moratorium on any regulatory action to restrict graduate medical education (GME) support from Medicaid. While Democrats and Republicans disagreed on extensions of moratoria that would delay implementation of seven Centers for Medicare & Medicaid Services (CMS) proposed Medicaid rules, congressional staff members on both sides were generally supportive of legislation delaying implementation of the Medicaid proposed rule affecting GME payments.

As previously reported, both the House and Senate introduced bills, HR 5613 and S 2819, respectively, to extend the moratorium delaying implementation of the Medicaid GME rule, which expires May 23, 2008 (AAIM Connection, April 11, 2008. However, as Hill Day participants learned during their meetings with congressional staff, Congress will not take further action on these bills. Instead, language to delay the moratorium on Medicaid GME cuts, in addition to the six other CMS-proposed Medicaid rules, is included in the draft House and Senate bills to fund the war in Iraq and Afghanistan.

As the legislation goes through the markup process, AAIM encourages you to contact your members of Congress and ask them to support the extension of the moratorium on cuts to Medicaid GME funding. To find contact information for your congressional representatives, please visit www.house.gov and www.senate.gov. AAIM will continue to keep its members updated on the status of the legislation.

Participants in APDIM Hill Day were Suzanne Brandenburg, MD, Gregory D. Clarke, MD, Maria C. DeOliveira, Gregory C. Kane, MD, John I. Kennedy, Jr., MD, Susan Lane, MD, Michael A. Nasiak, Niraj Sharma, MD, Sharon Silbiger, MD, Alwin F. Steinmann, MD, and Allan R.Tunkel, MD, PhD, as well as Nicole V. Baptista and Jessica L. O’Hara from the staff. Meetings were held with health staff for Senators Robert Casey (R-AL), Hillary Rodham Clinton (D-NY), John Ensign (R-NV), John F. Kerry (D-MA), Edward M. Kennedy (D-MA), Frank L. Lautenberg (D-NJ), Robert Menendez (D-NJ), Bill Nelson (D-FL), Harry Reid (D-NV), John D. Rockefeller, IV (D-WV), Charles E. Schumer (D-NY), Jeff Sessions (R-AL), Richard Shelby (R-AL), Arlen Specter (R-PA); Representatives Spencer Bachus (R-AL), Timothy Bishop (D-NY), Michael E. Capuano (D-MA), Diana DeGette (D-CO), Eliot Engel (D-NY), Barney Frank (D-MA), Jim Gerlach (R-PA), Dean Heller (R-NV), Stephen Lynch (D-MA), Jon C. Porter (R-NV), Debbie Wasserman Shultz (D-FL), Henry A. Waxman (D-CA); and the House Energy and Commerce and Senate Finance Committees. Participants also had the opportunity to meet with Representative Frank Pallone, Jr. (D-NJ), Chair of the House Committee on Energy and Commerce Subcommittee on Health, and Representative Shelley Berkley (D-NV).

For more information about APDIM Hill Day or visiting Capitol Hill, please contact Policy@im.org.

2. Administration Sets Deadline for Congress to Delay Physician Pay Cut

The Bush administration has set a June 16 deadline for Congress to submit legislation to delay a 10% cut to Medicare physician reimbursement rates. The legislation must identify cuts to Medicare expenditures that would offset the cost of reversing the cut. Senate Finance Committee Chair Max Baucus (D-MT) is drafting legislation that would cost an estimated $15 billion to $18 billion over five years to delay the physician payment cut for 18 months; the committee is still considering methods to offset the cost.

While Congress is in favor of delaying the physician pay cut before it is scheduled to take effect July 1, there is little consensus on how to create the offsets needed in order to pass legislation on the issue. According to House Energy and Commerce Subcommittee on Health Chair Pete Stark (D-CA), Senator Baucus will likely revise the current Medicare formula to exclude specific expenses when calculating the amount of money to provide per beneficiary. The slight change in the formula would ensure indirect medical education expenses, already being paid for by Medicare, are not inflating the formula for Medicare reimbursement rates.

Senator Olympia Snowe (R-ME) and Senator Kent Conrad (D-ND) also disclosed that finance committee members are still looking to reduce the incentive payments private insurers receive to administer Medicare Advantage (MA) plans as a potential offset for the bill. While MA plans are paid on average approximately 113% higher than traditional Medicare rates, the insurance industry lobby, conservative legislators, and the Bush administration have strongly opposed any suggestions to make cuts to MA plans.

President George W. Bush and his administration have set the June 16 deadline to ensure there is no disruption in physician payments and no sudden action from physicians to stop seeing Medicare patients. Senator Baucus said that Senate Majority Leader Harry Reid (D-NV) has pledged floor time for discussion of the legislation in early June. The House will face a quick turnaround time of two weeks to agree to and accept the Senate legislation and send it to President Bush before July 1.

The Alliance for Academic Internal Medicine—the nation’s largest academically focused specialty organization—consists of the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.

Please contact AAIM Vice President for Policy Charles P. Clayton (cclayton@im.org), AAIM Policy Coordinator Nicole V. Baptista (nbaptista@im.org), or AAIM Policy Assistant Jessica L. O'Hara (johara@im.org) at (202) 861-9351 with questions or comments about this week’s Merlin.