Look for an Active Year

Neurologists and other physicians can expect Medicare reimbursements, medical liability reform, and prescription drug issues to be revisited this year as President Bush and Republican leaders attempt to leverage the fall election gains in the House and Senate. But enacting key measures is far from certain. Despite titular control of 55 seats in the Senate, Republicans are still shy of the 60 votes needed to overcome a Democratic filibuster. Passing such bills "is not going to be a slam-dunk," said Jacque J. Sokolov, senior partner of Sokolov, Sokolov, Burgess, a health care consultancy in Scottsdale, Ariz. "But the likelihood of it happening is greater in a Bush- Republican Congress environment than it would have been in a Kerry environment." Increasing Medicare physician payments is largely an economic issue, not a political one. Any legislation to increase reimbursements faces an uphill challenge with the weight of a record $8.18 trillion federal debt limit and the threat of balanced budget measures looming. "Nobody is saying we should be cutting doctors' Medicare payments," said Mike Amery, federal affairs manager at the American Academy of Neurology (AAN) in St Paul. "It's going to have to do with deficit reductions and how much Congress is willing to spend. We're going to have to fight for adequate reimbursement." Under the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and other legislation, payments for physician services will increase an average of 1.5% this year. This follows a similar 1.5% increase in 2004 and reverses cuts of 4.5% that had been programmed for each of the 2 years. The increases translate into an additional $64 million for neurologic services, according to the AAN. But unless the issue is revisited this year, the formula the government uses to compute Medicare reimbursements will likely trigger significant cuts to neurologists and other physicians beginning next year. "That will cause a catastrophe not only to physicians but to the Medicare patients they serve," predicted Amery. Sokolov foresees a new MMA of 2005 being crafted this year to "fix" this and other areas needing adjustment. "Whenever you have a bill the magnitude of the previous MMA, there's almost always an omnibus reconciliation act of some kind," he explained. "It really comes down to going back and looking at what's working and what's not." Regarding tort reform, the Senate has been the roadblock, and there's no guarantee this year will be different. Some of the 55 Republicans are opposed to tort reform, while some of the 44 Democrats are in favor. The result still nets out at around 55 votes, 5 votes shy of the 60 needed to force a vote. "That's going to require a compromise if we're going to find a solution that gets us some type of reform," Amery said. In the end, he added, it's not just about capping damages. "It's about making sure insurance rates go down," he said. Also likely to be on the docket this year are prescription drug formularies and pricing issues. Starting in 2006, the Medicare prescription drug benefit will give elderly and disabled patients substantial assistance for covered prescription medications. But deciding which drugs will be covered is a complex matter. The MMA authorized the United States Pharmacopeia (USP), a nonprofit, nongovernmental organization, to develop model guidelines listing categories and classes of therapeutic drugs that prescription drug plans can use to develop their formulary, or list of covered drugs. The USP published draft model guidelines last August, which Amery characterized as "severely lacking" in the number of categories necessary to ensure that patients with neurologic conditions had access to medications. "Particularly in MS and epilepsy, the drugs simply were not there," he said. The AAN has been meeting with USP officials, and will examine the final recommendations when they are issued this month. Members of Congress have been generally supportive of neurologists' concerns, said Bennett Lavenstein, MD, a pediatric neurologist whose practice is in Fairfax, Va, and at Children's National Medical Center in Washington, DC. He was 1 of 50 neurologists in an AAN group to visit legislators last year to press for Medicare reimbursement, malpractice reform, and other issues. No legislators argued against the issues, Lavenstein said, "but to the degree anybody could do anything about it was another issue because of the demands on federal dollars." ?