[Congressional Record Volume 154, Number 176 (Wednesday, November 19, 2008)]
[Senate]
[Pages S10618-S10619]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  Mr. BARRASSO. Mr. President, today I come to the floor to tell the 
Nation a story, and it is the story of a Wyoming doctor, a doctor by 
the name of Randy Johnston. He is an ophthalmologist who practices in 
Cheyenne, WY. He is very qualified. He is very capable. He is also a 
good friend.
  The reason I come to tell you this story is because, like many 
doctors across the country, Randy takes care of people on Medicare, and 
occasionally in his practice as an ophthalmologist he gives shots to 
people on Medicare. As a matter of fact, there is a picture of Dr. 
Johnston on the front page of the American Medical News. This is an 
article dated November 10, written by Jane Cys, and it shows Dr. 
Johnston in his office in Cheyenne getting ready to give a shot.
  Well, in the past, Randy would buy the drugs that his practice uses 
and then bill the patients for the treatment. The drugs that Randy uses 
are typically injected, but under this Part B Medicare drug program 
some are infused through a patient intravenously right into the vein.
  Two years ago, Randy enrolled in a new program created by the 2003 
Medicare Modernization Act. This Medicare Part B program was called the 
Competitive Acquisition Program--CAP is the phrase they use. It was 
designed to give doctors a choice in the way they administer the drugs.
  Under the program, the doctor would first see the patient, then order 
the medicine from a Government vendor, then get the medicine, and then 
give the injection.
  Well, the way it worked is, Medicare would then pay the vendor for 
the drugs. Medicare also would bill the patient if there was a copay or 
a premium the patient owed. Randy was only responsible to bill Medicare 
for the actual treatment of the patient, not for the medicines.
  Congress and the Centers for Medicare and Medicaid Services hailed 
this new program as a way to alleviate administrative burdens and 
reduce Medicare costs--a good idea. Doctors could now spend more of 
their time with their patients rather than serving as drug purchasers 
and bill collectors.
  Randy signed up for the program early, and the program that was 
passed as part of the 2003 bill finally got started in 2006. Randy 
thought it made good sense for him, good sense for his patients. Some 
of his Medicare patients could not afford to pay for their office-
administered drugs, and Randy saw great potential in this new program. 
He could transfer the Medicare billing part of it to someone equipped 
to handle the administrative redtape, and this freedom would leave him 
more time to focus on practicing medicine.
  The program has now been in place for 3 years. What are the results? 
Well, only 4,200 doctors signed up for the program. You may ask, why is 
that? Dr. Johnston can tell you, and this article in the American 
Medical News explains it very well. Administrative hassles, burdensome 
drug transportation and storage rules, and vendor delivery problems--
and that is just to name a few.
  For example, the Government rules require doctors to give patients 
the drugs only in the facility where the vendor delivered the 
medicine--no exceptions, none. This requirement prevented doctors from 
moving drugs between their main office and a part-time satellite office 
they may have in another community.
  Washington bureaucrats simply do not understand what a burden this 
policy can be in rural and frontier communities. Seniors living in 
rural States such as Wyoming often have to travel great distances--
hundreds of miles--to see a specialist like Dr. Randy Johnston. This 
program, with good intentions, clearly was not designed to meet the 
unique needs facing rural patients and health care providers who work 
tirelessly to serve their patients.
  Dr. Johnston was also required to order the drugs for a specific 
individual patient by name. He was not allowed to restock a general 
office supply to use on multiple patients.

[[Page S10619]]

  I understand the Government is trying to prevent drug stockpiling. 
But this rigid program requirement does not give doctors the 
flexibility they need to practice medicine. This is especially true in 
emergency situations.
  So who is liable when a patient comes to the doctor's office needing 
immediate treatment but the doctor cannot help because he has to call 
the Government to send the medicine in the first place, even if he has 
a supply on hand for another patient? The program's current design has 
turned out to be a bureaucratic nightmare.
  After only 3 months in the program, Randy Johnston wrote Medicare a 
letter begging--I say begging--to be let out of the program. Why? Well, 
it was not just the excessive paperwork and the excessive phone calls 
to get the medication; Randy saw how absolutely wasteful this 
Government program had become.
  When Dr. Johnston purchased Medicaid vials himself from a local 
pharmacy, the local pharmacy would divide it into multiple doses that 
could be used for different patients. Using the new Medicare program, 
Dr. Johnston had to order an entire vial for each patient, use the one 
dose the patient needed, and then throw the rest away.
  Why would Medicare force seniors and taxpayers to foot the bill for 
an entire vial of medication containing 400 doses when the patient only 
needed 1 dose? At a time when Americans are facing such painful 
financial times, this wasteful Government spending is appalling. We are 
talking about lifesaving medicine, expensive medicine. I do not know 
anyone who buys a loaf of bread, takes out one piece and eats it, and 
throws away the rest of the loaf. This makes no sense to anyone.
  It is well past the time that Washington bureaucrats start treating 
taxpayer dollars like the money in their own personal checkbooks. When 
emergencies, illnesses, or major household repairs occur in our 
families, we find a way to pay the bill. We look at our budgets, we 
tighten our belts, and we find alternative places to save. We eliminate 
luxury items. We stop wasteful spending.
  Dr. Johnston was absolutely right to try to get out of this 
absolutely wrong, wasteful program. Washington bureaucrats who have 
never been on the front lines treating Medicare patients developed this 
program. They do not understand the practical applications. So I was 
not surprised when Medicare announced in September of this year they 
were putting the entire program on hold starting in January 2009. 
Washington bureaucrats claim they are considering alternative ways--
alternative ways--to improve the program because they want it to 
succeed.
  The new administration has a tremendous opportunity to learn from 
Randy Johnston and from the 4,200 other participating doctors. Rather 
than hamstring providers, perhaps Washington should start to focus its 
efforts on eliminating waste, eliminating fraud, and eliminating abuse 
in the Medicare system.
  This year alone, we have seen one news report after another 
uncovering Medicare wasting money. These news reports sound the alarm 
to every hard-working taxpayer in the sound of my voice and all hard-
working taxpayers across America.
  Who is holding these bureaucrats accountable? Just this week, the 
Department of Health and Human Services issued the Agency Financial 
Report. This document shows that in fiscal year 2008, these Government 
check writers made $10.4 billion--$10.4 billion--in improper Medicare 
fee-for-service payments. We can do better. We can do much better than 
this.
  Wasteful spending strips Medicare of the vital resources that are 
needed to care for our elderly, to care for our frail, to care for the 
vulnerable. The new administration has a real opportunity to show 
leadership. Working together, we can fix this flawed policy. Medicare 
patients, doctors who take care of Medicare patients, and the American 
taxpayers deserve nothing less.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll of the Senate.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BARRASSO. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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