[Congressional Record Volume 154, Number 38 (Thursday, March 6, 2008)]
[Senate]
[Pages S1706-S1707]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORNYN:
  S. 2729. A bill to amend title XVIII of the Social Security Act to 
modify Medicare physician reimbursement policies to ensure a future 
physician workforce, and for other purposes; to the Committee on 
Finance.
  Mr. CORNYN. Mr. President, you don't have to be an expert in health 
care policy to know our health care system is in need of reform. Today, 
we spend over $2 trillion on health care, almost $7,500 per person. In 
10 years, national health care expenditures are expected to reach $4.3 
trillion, or $13,000 per person, which would comprise 19.5 percent of 
our gross domestic product. Clearly, this rate of increase is 
unsustainable. We must work together to develop creative solutions that 
will change the way we deliver health care. The goal should be to allow 
health care providers to develop treatment plans based on what is in 
the best interest of the patient. But the current system under which we 
pay physicians neither puts patients first nor reduces costs.
  A decade ago, instead of creating a mechanism that changed the way 
physicians deliver care, Congress attempted to curb rising health care 
costs through an arbitrary annual expenditure cap on physician 
payments. And what has the result been? Physicians have seen their 
reimbursements lag far behind their costs, in Texas and nationally--a 
15-percent gap. In order to recoup lost revenue, physicians often 
increased the number of patients they were seeing per day, meaning they 
were spending less and less time with their patients, lowering the 
quality of care delivered. Moreover, we are starting to see problems 
with beneficiary access. At an increasing rate, beneficiaries across 
the country are reporting difficulties in scheduling appointments with 
their physicians.
  But declining reimbursements are also influencing the development of 
future generations of physicians--especially in primary care--as there 
is a disincentive to enter the profession or an incentive to forgo 
primary care for more lucrative specialties. This is especially 
alarming, as the Medicare population grows and many physicians will be 
retiring. For example, my State of Texas already has a below-average 
physician-to-population ratio, while 39 percent of practicing 
physicians are already over 50.
  There are over 30 health care reform plans floating around inside and 
outside of Congress. Few of these plans address the fundamental 
question: What good is coverage without access to that coverage?
  If we are serious about changing our health care system, we need to 
start with changing the way we pay physicians--that would send a strong 
message not only about the need for better quality care but also the 
need to ensure a future generation of American physicians.
  I am pleased to introduce the Ensuring the Future Physician Workforce 
Act of 2008. This bill will provide positive reimbursement updates for 
providers; eliminate the ineffectual expenditure cap; increase 
incentives for physician data reporting; facilitate adoption of Health 
Information Technology, HIT, by addressing cost and 
legislative barriers; educate and empower physicians and beneficiaries 
in relation to Medicare spending and benefits usage; and study ways to 
realign the way Medicare pays for health care.

  Every few years, Congress goes through the same rituals of trying to 
fix the physician reimbursement mechanism. First, CMS tells us the 
expenditure cap requires Medicare physician reimbursements to be cut by 
a certain percent. Next, Congress struggles to find a way to prevent 
this cut, knowing how harmful it would be. Yet delaying this cut is 
extremely expensive. Congress then swears that this is the last time 
they will go through this process and that it must come up with a 
comprehensive fix. Ultimately, Congress never seems able to fix the 
problem. This bill stops the charade, resets the baseline for the next 
year and a half, and then eliminates the expenditure cap thereafter. 
Rather than pretending like we are going to adhere to an arbitrary cap 
of $80, for example, only to spend more later, this bill puts up front 
the true cost that we are really going to spend $100 or $101. The 
effect on spending is the same, but physicians and beneficiaries have 
certainty.
  If Congress fails to act, Texas physicians will lose $860 million 
between July 2008 and December 2009, which is a cut of $18,000 to each 
Texas physician. That figure balloons to $16.5 billion by 2016 due to 
nearly a decade of scheduled cuts.
  Two widely identified ways of moving toward lower costs and better 
quality stem from the collection of health care data and the 
implementation of health information technology.

[[Page S1707]]

  First, increasing incentives for the reporting of data will improve 
our ability to assess how we deliver care and the level of that care. 
In this bill we go beyond general reporting and focus on the most 
expensive diseases. The director of the Congressional Budget Office, 
Peter Orszag, likes to ask the paradoxical question: ``How can the best 
medical care in the world cost twice as much as the best medical care 
in the world?'' It does because we deliver care in vastly different 
ways and at vastly different costs. By focusing our data collection 
efforts, we will better understand how these differences occur.
  Second, there are few who would argue with the notion that 
implementation of HIT is beneficial from a cost and quality 
perspective; HIT provides transparency, efficiency, portability, 
safety, and reductions in duplicative and wasteful procedures. However, 
various cost and legislative barriers have inhibited widespread 
adoption. There is a large cost associated with implementing HIT 
because of the cost of hardware, software, and time needed to train 
staff. Additionally, there is a disincentive to invest in HIT because 
the Department of Health and Human Services has yet to finalize its 
standards. Providers are stuck in neutral.
  Under the current regulatory environment, doctors have limited 
ability to accept hardware, software, or help in training from 
hospitals. Not only does this unfairly harm patients in these 
practices, it negatively impacts community health. This bill provides a 
safe harbor to that regulation but maintains the spirit of the law by 
allowing hospitals to help physicians in their implementation of HIT--
either in the purchasing of hardware or software or in training--as 
long as these hospitals do not restrict the physician's 
interoperability, clinical practice, or referral system for their own 
financial benefit. This bill provides the incentive to voluntarily 
implement HIT and commonsense regulations that move communities into 
the 21st century. Once beneficiaries begin to see the benefits HIT will 
have on the quality of their care and in their wallets, providers will 
not be able to ignore the demand.
  Finally, this bill would provide comparative reports to physicians on 
their billings and to beneficiaries on their usage of services. 
Physicians want to do the right thing for their patients, but we need 
to ensure that they have the tools necessary to appropriately deliver 
that care. When physicians look at these reports and see how they 
compare to other providers in their area or across the Nation, they 
will take that report seriously and evaluate why their practices 
differ. Similarly, beneficiaries will have a tool to evaluate their 
level of care and a tool to engage the physician-patient relationship.
  Mr. President, it is no secret that the path Medicare is on is 
unsustainable. So far, our only recourse has been to prolong the 
inevitable collapse, rather than reforming the doomed system. This bill 
is a small step toward righting the Medicare ship, and with it, 
America's health care system as a whole. It is time we move forward in 
health care and help create a system that provides the best care at the 
best prices. I hope my colleagues will join me in supporting this bill 
and ensuring a better future for American health care.
                                 ______