The Senate is scheduled to vote on Saturday night at approximately 8:00 PM EDT on a motion to proceed with debate on the health care reform bill.  The bill and summary can be found on the Community Oncology Alliance (COA) website at www.communityoncology.org under Immediate Action Needed.

Understand that this vote, although very important, is simply to move the bill to the Senate floor for debate.  Sixty Senators are needed to overcome a filibuster of the motion, so that means that each of the 58 Senate Democrats and 2 Independents who caucus with the Democrats need to cast a yea vote for the motion.  If this does not happen, health care reform in the Senate goes back to the drawing board.  The most likely scenario is that the immense pressure of fellow Senators and the White House will persuade hold-outs such as Senators Blanche Lincoln (D-AR) and Mary Landrieu (D-LA) to allow the motion to proceed.  Senators Joe Lieberman (I-CT) and Ben Nelson (D-NE) have already indicated agreement to vote for the motion.  It is likely that not one Republican will vote yea.  However, anything can happen.

If the motion passes, there is still a long way to go, likely dragging into 2010.  It will take the Senate weeks after Thanksgiving to pass a bill, if they can, and then the House and Senate bills will be merged in conference.  Given all of the hot issues surrounding the health care debate, there is no certainty that a final vote on a final bill can be passed by both the House and the Senate.  Stay tuned.

We will have more analysis on the Senate bill in relation to oncology; however, here are a few highlights.

The bill includes a one-year patch to the Medicare physician fee schedule that would overcome the scheduled 21.2% physician reimbursement cut and replace it with a 0.5% increase to the conversion factor.  After that, without additional congressional action, the 2011 scheduled cut would go into effect.  The recent passage of the House bill (H.R. 3961) to fix the payment system was more political pomp than circumstance.  The Senate has already tried to pass a similar bill but could not muster the 60 votes needed to proceed on the Senate solution (S. 1776).  So, it looks like the medical community is looking at another one-year Band-Aid, if a health care reform bill passes.  Because it is unlikely to happen before the end of the year, it is a distinct possibility that the 21.2% cut may go into effect, until if and when this is reversed by passage of a final healthcare reform bill.

The Senate bill contains substantial cuts to Medicare by transforming the system from fee-for-service, quantity-based reimbursement to payment tied to quality and cost control.  We will provide details in upcoming emails.

COA held a Capitol Hill briefing this week to present preliminary results from the Components of Care Study and the results/impact of the 2010 Medicare payment cuts to oncology. That presentation is on the COA website, also under the Immediate Action Needed section.  We will provide more perspective on this early next week.