American College of Cardiology

Speaking at an Alliance of Specialty Medicine Capitol Hill “fly-in” last week, Republican and Democratic legislators confirmed what many pundits have been saying for several weeks: the passage of a comprehensive Medicare reform package, including a prescription drug benefit, will be very difficult. The Alliance-a coalition of 13 physician specialty societies, of which [specialty society name] is a member—held the event as part of its ongoing lobbying efforts around medical liability reform and Medicare reimbursement.

"We certainly want to [pass Medicare reform] and there is a will to do it,” said Sen. George Allen, R-Va. Whether that will translate into a final bill, he said, is another question. In fact, there was unanimous sentiment among all six legislators who spoke during the event that differences between Democrats and Republicans—and even among Republicans—could derail the process altogether. It will be a “difficult struggle,” said Rep. John Shadegg, R-Ariz., who was one of the few Republicans to vote against the House-passed Medicare reform package, on the grounds that the prescription drug benefit provisions in it “would not get the job done” because there is nothing in the package to restrain the growth in the cost of drugs.

Of special interest to Alliance member organizations is a provision in the House-passed Medicare reform package that would give physicians a 1.5 percent increase in Medicare fees in 2004 and 2005—as opposed to the 4.2 percent cut that is slated to take effect on January 1 under the proposed 2004 Medicare fee schedule released in September.

Despite the suspect future of the larger Medicare reform bill, one legislator, Rep. Mark Foley, R-Fla., was optimistic that Congress would pass legislation to prevent a cut in physicians’ Medicare fees next year. “Regardless of what happens with the [Medicare reform package], we’re going to address physician payments,” he said to applause from the Alliance member physicians in attendance.

Rep. Foley and Rep. Sherrod Brown, D-Ohio, who also spoke during the Alliance event, have sent a letter to Speaker of the House Dennis Hastert, R-Ill., and House Democratic Leader Nancy Pelosi, D-Calif., requesting that Medicare physician payment provisions be carved out of the current Medicare reform conference committee discussions and addressed as a stand-alone bill. While cautioning that there is limited money available for a laundry list of domestic priorities, all of the legislators uniformly voiced support for physicians.

Continued cuts in physicians’ Medicare reimbursement is “not good public policy,” said Rep. Brown. Without congressional action, added Rep. Shadegg, “we could see a situation a decade from now where there aren’t enough doctors to take care of us.”

All Alliance member societies are urging their physician members to contact their House representatives and tell them to sign onto the Foley/Brown letter on Medicare physician payment, and to contact their Senators and tell them to sign onto a similar letter to the Senate leadership from Sens. Arlen Specter, R-Pa., and Jeff Bingaman, D-NM.

Liability Reform Fight Continues
The legislators also addressed the Alliance’s other top priority at the moment: medical liability reform. It is unlikely that comprehensive federal liability reform legislation can pass this year, some legislators said. However, an incremental approach is being considered that initially would provide new liability protections for the specialties at highest risk, such as obstetrics/gynecology, with protections for other physicians to be addressed in future legislation.

Considering the stark differences between Democrats and Republicans on how to approach medical liability reform, the specialty-by-specialty approach could work, said Sen. Allen. And although tort reform has often been considered a state issue, noted Rep. Eric Cantor, R-Va., there is a growing consensus in Congress that the liability crisis has reached the point where “people are starting to realize that this is a federal issue.”