As you know, the Senate health care reform bill just squeaked by with enough votes this past Saturday night to start debate on the Senate floor.  As we communicated last week, this vote was expected because it would have been very difficult for any Senate Democrat to vote against the bill at least proceeding to debate.  However, there is a long way to go as leaks in the Democratic coalition were all too obvious during the Sunday talk shows.  Already, Senators are talking about what needs to be changed in the bill, especially relating to hot issues such as the public plan and abortion.

The likely scenario is that the Senate takes at least until Christmas, if not the end of the year, to pass a bill.  Then, the Senate and House bills have to be merged in a conference committee.  If indeed the Senate can actually pass a compromise bill, the compromises will have to continue in order to merge very different Senate and House bills.  The key target date for a merged bill that passes both House and Senate, and is signed by the President, is before the State of the Union address.  Understand that although there will be incredible pressure on Senate and House Democrats to deliver a bill, the political stakes are enormous during the 2010 election year.  

You should be aware of a few key points relating to the Senate bill that will be debated and revised right after the Thanksgiving week.

Most immediate, the Senate bill contains a one-year patch that would avert the 21.2% cut to Medicare reimbursement for all physician services.  Although the House has just passed a bill that goes beyond a simple patch, right now that bill is DOA in the Senate because it costs $210 billion.  Additionally, the Senate has already tried but failed to pass a stand alone bill (S. 1776) addressing the flawed sustainable growth rate (SGR) formula.  

So, right now averting the 21.2% payment cut is tied to passage of the Senate bill. There is talk about the possibility of the Congress passing a separate bill before the end of the year averting the payment cut on a short-term basis.  However, if that does not happen, your practice needs to be prepared for substantially lower Medicare payment starting on 1/1/2010.  Even if the cut is eventually overturned in early 2010, it will take time for the Centers for Medicare & Medicaid Services (CMS) to process the correct reimbursement for submitted claims.

Additionally, you need to be aware that without additional congressional action, the planned Medicare cuts to drug administration, consultations, and diagnostic imaging will go into effect on 2010.

In terms of other provisions in the Senate bill impacting oncology, half of the 10% bonus for primary care and general surgery will be paid for by reducing reimbursements for all other Medicare services, which includes oncology.  There are payment cuts to diagnostic imaging; however, these are less than those planned by CMS.  Additionally, there are projects that involve bundling of payments and creating accountable care organizations that are aimed at fundamentally transforming the payment system, especially in terms of reducing reimbursement.  The creation of an Independent Medicare Advisory Board to rein in spending is especially troubling.

On the COA website at www.communityoncology.org under Immediate Action Needed we have posted both the Senate and House bills, as well as summaries.  The section summaries give a good overview of what is in both bills.

The severe 2010 Medicare cuts to oncology were averted because of the outreach from community oncology to members of Congress.  In case you do not understand, health care reform has become all about politics.  That is why it is essential to be engaged in the debate and to let your House and Senate members of Congress know of the crisis in cancer care.

COA will be providing more information, materials, talking points, and direction right after the Thanksgiving holiday.  Until then, we wish you and your family the best!