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Senate debates Medicare bill

Legislation to overhaul Medicare payments

The Senate has until Tuesday to debate a bill that would overhaul how Medicare payments are made. The Medicare Access and the Children's Health Insurance Program (CHIP) Reauthorization Act is commonly known as the doc fix bill. The measure was passed 392-37 in the House of Representatives with overwhelming approval last month, in a rare show of bipartisan support.

The measure would change what many people agree is a flawed system for paying doctors who treat Medicare patients. The House sent a bill to the Senate that would repeal the sustainable growth rate (SGR). Under the SGR, the idea was to keep increases in Medicare reimbursement from exceeding changes in the nation’s GDP. However, every year since, the growth of health care costs has exceeded the GDP’s. And rather than revise the system, Congress voted numerous times and spent $150 billion to approve a doc fix.

Under the new legislation, doctors will receive rewards or penalties on the basis of patient health outcomes. If the Senate does not pass its version of the bill by April 15, doctors who treat Medicare patients could see their fees cut by 21 percent.

President Barack Obama says he will sign the bill if it passes the Senate. An estimated 54 million elderly and disabled people across the country rely on Medicare.

Al Jazeera’s Libby Casey said that “this is something that both parties have wanted to fix for a long time. They’ve made temporary fixes 17 times, and what is so unique is that they were able to compromise on something in what’s usually a very divided Congress.”

Democrats agreed that some enrollees would foot some of the bill, and Republicans said that it wouldn’t all have to be paid for and agreed to extend CHIP and funding for community health centers.

Discussing some of the sticking points on the measure, Casey said, “Some conservative Republicans really want to see this directly paid for, while some Democrats are concerned over an anti-abortion provision in the bill that deals with abortions at community health centers.”

During Al Jazeera America’s Sunday night segment The Week Ahead, Erica Pitzi spoke to Dr. Abdul El-Sayed, an assistant professor at Columbia University, and Susan Dentzer, a senior health policy adviser at the Robert Wood Johnson Foundation, who joined the conversation from Washington, D.C.

Sayed said, “Medicare is one of the most important and largest issues that we pay for as a national government. We’ve known for quite a long time that folks on both sides of the aisle hate the way that Medicare is paid for right now, as do doctors, as do Medicare beneficiaries. So this is one of those rare issues in our national discourse that actually brings together multiple sides on the same conversation.”

He added that the doc fix bill starts the conversation on how to pay for value rather than for service. One of the big issues in the way we pay for Medicare is that it incentivizes doctors to sometimes do things just because they can get paid for them, not because it’s what’s best for their patients.

“The volume of physician services under Medicare has been growing for many years,” said Dentzer. “Some people worry that because of the way we pay doctors in the traditional program on a piecework basis, it’s like paying cobblers to make shoes based on every pair of shoes they make, regardless of whether people wanted to buy those shoes and if they are any good. The incentive was for doctors to do more and more because they got paid on this piecework basis, and the rates of those expenditures were going way up.”

That’s led some people to say that the current system is responsible for fraud, with doctors ordering more tests than needed just to get Medicare reimbursements. As Sayed explained, “Doctors who are paid in a fee-for-service model, their incentive may be to upsell you, which contributes to an overall increase in Medicare costs.”

Dentzer said the new measure is a good one. “It’s ridiculous to go through this exercise year after year where Congress knows the payment cuts are coming and forestalls them. It’s a distraction that keeps us away from what we really need to do as a country, which is shift the way we pay physicians under Medicare.”

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