[Congressional Record Volume 156, Number 153 (Monday, November 29, 2010)]
[House]
[Pages H7618-H7621]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
THE PHYSICIAN PAYMENT AND THERAPY RELIEF ACT OF 2010
Mr. PALLONE. Madam Speaker, I move to suspend the rules and concur in
the Senate amendments to the bill (H.R. 5712) to provide for certain
clarifications and extensions under Medicare, Medicaid, and the
Children's Health Insurance Program.
The Clerk read the title of the bill.
The text of the Senate amendments is as follows:
Senate amendments:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``The Physician Payment and
Therapy Relief Act of 2010''.
SEC. 2. PHYSICIAN PAYMENT UPDATE.
Section 1848(d)(11) of the Social Security Act (42 U.S.C.
1395w-4(d)(11)) is amended--
(1) in the heading, by striking ``november'' and inserting
``december'';
(2) in subparagraph (A), by striking ``November 30'' and
inserting ``December 31''; and
(3) in subparagraph (B)--
(A) in the heading, by striking ``remaining portion of
2010'' and inserting ``2011''; and
(B) by striking ``the period beginning on December 1, 2010,
and ending on December 31, 2010, and for''.
SEC. 3. TREATMENT OF MULTIPLE SERVICE PAYMENT POLICIES FOR
THERAPY SERVICES.
(a) Smaller Payment Discount for Certain Multiple Therapy
Services.--Section 1848(b) of the Social Security Act (42
U.S.C. 1395w-4(b)) is amended by adding at the end the
following new paragraph:
``(7) Adjustment in discount for certain multiple therapy
services.--In the case of therapy services furnished on or
after January 1, 2011, and for which payment is made under
fee schedules established under this section, instead of the
25 percent multiple procedure payment reduction specified in
the final rule published by the Secretary in the Federal
Register on November 29, 2010, the reduction percentage shall
be 20 percent.''.
(b) Exemption of Payment Reduction From Budget-
neutrality.--Section 1848(c)(2)(B)(v) of the Social Security
Act (42 U.S.C. 1395w-4(c)(2)(B)(v)) is amended by adding at
the end the following new subclause:
``(VII) Reduced expenditures for multiple therapy
services.--Effective for fee schedules established beginning
with 2011, reduced expenditures attributable to the multiple
procedure payment reduction for therapy services (as
described in subsection (b)(7)).''.
SEC. 4. DETERMINATION OF BUDGETARY EFFECTS.
The budgetary effects of this Act, for the purpose of
complying with the Statutory Pay-As-You-Go Act of 2010, shall
be determined by reference to the latest statement titled
``Budgetary Effects of PAYGO Legislation'' for this Act,
submitted for printing in the Congressional Record by the
Chairman of the Senate Budget Committee, provided that such
statement has been submitted prior to the vote on passage.
Amend the title so as to read: ``An Act Entitled The
Physician Payment and Therapy Relief Act of 2010.''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New
Jersey (Mr. Pallone) and the gentleman from Oregon (Mr. Walden) each
will control 20 minutes.
The Chair recognizes the gentleman from New Jersey.
General Leave
Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and include extraneous material on concurring in the Senate amendments
to H.R. 5712.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New Jersey?
There was no objection.
[[Page H7619]]
Mr. PALLONE. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, this bill is a stopgap measure to guarantee that
seniors and military families can continue to see their doctors during
December while we work on a solution for the next year. Without this
legislation, the fees Medicare pays to physicians will be reduced by 23
percent on December 1, this Wednesday. And because TRICARE, the
civilian health program for military families and retirees, uses
Medicare rates, fees for physicians seeing TRICARE patients would be
cut by 23 percent as well.
Madam Speaker, I have to say that kind of cut is obviously not
reasonable. We have a responsibility to ensure that Medicare is a
steady partner for physicians so that we are able to maintain the kind
of excellent access to care that seniors and people with disabilities
have come to expect from the program. Medicare enrollees still enjoy
better access to care than anyone else in the country. The rate cuts
created by the SGR would undermine that trust that seniors and
physicians have historically had in the program.
The 111th Congress has passed into law three SGR extensions of less
than a year, and this will be the fourth. I think we need to stop
legislating SGR policy in 1 to 6 month intervals in order to provide
some stability to the Medicare program for 2011. And I hope that before
the 111th Congress adjourns, we can pass legislation addressing all of
2011 at a minimum.
I continue to be frustrated that we are unable to move beyond short-
term fixes to this major problem facing the Medicare program. The House
passed legislation in 2009 that I co-sponsored that would have dealt
with this SGR problem for good; but until we have that long-term
solution in hand, it is essential that Congress pass this legislation
to ensure that seniors and military families do not experience a
disruption in seeing their doctors this December.
This legislation, Madam Speaker, is completely paid for over 10
years. According to the rules of the statutory PAYGO law, we aren't
supposed to pay for SGR bills; but this one is paid for despite that.
It moved through the Senate by unanimous consent.
And so, Madam Speaker, there is no conceivable reason in my opinion
to oppose this legislation. I would urge Members to vote ``yes'' on
this bill and help me pursue a longer solution before Congress finishes
business for this year.
I reserve the balance of my time.
Mr. WALDEN. Madam Speaker, I rise today in support of the Physician
Payment and Therapy Relief Act.
On Wednesday, doctors who participate in Medicare will face a 21
percent cut in their reimbursement rates. It is unfortunate that we are
again debating only a short-term solution to this problem. Thirty-day
patches and 60-day fixes do not provide the certainty necessary for
physicians to properly run their practices. Yet, inaction today would
disrupt the Medicare system and jeopardize seniors' access to care just
as the holidays are approaching.
We should pass H.R. 5712, but we must begin working on a long-term,
financially viable solution to fix the manner in which physicians are
reimbursed under Medicare. The first step must be to repeal the new
health care law. The health law cut over $500 billion from Medicare to
expand Medicaid and create a new entitlement program, while completely
ignoring the looming payment crisis that we must act on with this
legislation today. Unfortunately, I think for the last 4 years there
has not been a single hearing held on this particular issue. That is
long overdue to be done.
So while the majority scrambles today to find money to fix the
Medicare reimbursement system, we should remember that they
deliberately chose not to do this with their disastrous health care
law. They needed the law to appear less expensive, and the Medicare doc
fix was simply ignored.
I support H.R. 5712 to provide a temporary reprieve from the
reimbursement cut scheduled to take effect Wednesday; however, we must
find a solution to the pending 26 percent cut scheduled to take effect
now in January. And we have to work together to develop a longer term
solution that does bring stability to the Medicare program.
Madam Speaker, I reserve the balance of my time.
Mr. PALLONE. Madam Speaker, I yield 3 minutes to the gentlewoman from
Texas (Ms. Jackson Lee).
(Ms. JACKSON LEE of Texas asked and was given permission to revise
and extend her remarks.)
Ms. JACKSON LEE of Texas. Madam Speaker, I thank Mr. Pallone for his
constant leadership on health care matters, and the Energy Committee
and its full complement of members, as well as Mr. Stark for his
continued strength on the issues of providing fairness and balance in
the health care system of America. To the managers, my colleagues on
the other side of the aisle, I appreciate the recognition that we have
a bipartisan crisis and that we all have to address the pending concern
of a potential cut as we move forward into 2011. But during the
Thanksgiving holiday as I was in my district, I saw a table of doctors
in a restaurant who felt compelled to come and ask me to support what
is called the doctor fix, the Medicare fix. I had to assure them that
Members of Congress were equally concerned about the providers of
health care, the implementers of good health for America having to face
this kind of dastardly crisis.
In the State of Texas it is crucial, a State that has the highest
number of uninsured and a rising number of impoverished who do not have
access to health care, this kind of disaster would be more than a
hurricane. And so I rise today to support this legislation to
acknowledge the fact that doctors and Medicare go together and they
equal good health for our constituents.
Seniors have to go to doctors and expect good health care. Doctors
are in fact those who take the oath to ensure that they care for the
sick and the feeble. The Houston Chronicle reported that more than 300
Texas doctors have dropped the Medicare program in the last 2 years, 50
in the first 3 months of 2010, because of this crisis. Many people
think of doctors as rich and able; but many of our doctors are in rural
areas and inner city areas and their goal is to serve patients who are
in need, many without any other means other than Medicare and Medicaid.
According to Dr. Susan Bailey, president of the Texas Medical
Association, the Medicare system has to be fixed and action must be
taken to ensure that Medicare payments to physicians are not
drastically cut. It is a shame to say, doctors have overhead, they have
offices, they have nurses, they have equipment that they have to pay
for, and that is part of good health care. And so I think it is
important that we look at this legislation as it comes to us, and that
the final physician rule, the Centers for Medicare and Medicaid
Services, modify the MPPR policy to apply a 25 percent reduction rather
than the proposed 50 percent reduction to physician Medicare payments.
However, I think the reduction in itself is an oxymoron because the
question is what are the needs of the patients and how can the doctors
care for them and how do we ensure that doctors and Medicare work
together to make sure that good health is promoted across America.
{time} 1420
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. PALLONE. I yield the gentlewoman another 30 seconds.
Ms. JACKSON LEE of Texas. While that reduction shows movement in the
right direction, any reduction will hinder the ability of doctors to
effectively treat patients who need their care and who are the most
vulnerable--pregnant women, children, the elderly and, of course, the
feeble, who are suffering from preexisting diseases or chronic
illnesses. So it is important that H.R. 5712, the Physician Payment and
Therapy Relief Act of 2010, is passed.
What I would ask, Madam Speaker, is: Who are we if we cannot take
care of the least of those?
I don't consider doctors wanting more than they deserve. I consider
doctors getting what they deserve to help care for the sick of this
Nation. I hope that we will have a bill that the President can sign and
that we will be able to address the question of good health care in
America.
Madam Speaker, I rise today in support of the amendment to H.R. 5712,
``The Physician Payment and Therapy Relief Act of 2010.''
[[Page H7620]]
Under the current health care law, more than 32 million additional
Americans are expected to get insurance, either through an extension of
Medicaid, the state-federal program for the poor, or through exchanges
where low- and moderate-income individuals and families will be able to
purchase private insurance with federal subsidies. The measure will
require most Americans to have health insurance coverage; and it will
regulate private insurers more closely, banning practices such as
denial of care for pre-existing conditions. A key part of the new
health law also encourages the development of ``accountable care
organizations'' that would allow doctors to team up with each other and
with hospitals, in new ways, to provide medical services. There are
some very good provisions that seek to ultimately benefit the public.
Today, however, increasing numbers of doctors are not accepting
Medicare patients because the payments they are receiving are
inadequate to cover basic expenses of administering care. In fact the
Houston Chronicle reported that more than 300 Texas doctors have
dropped the program in the last two years, including 50 in the first
three months of 2010. According to Dr. Susan Bailey, president of the
Texas Medical Association, the Medicare system is on the verge of
imploding unless action is taken by Congress to ensure that Medicare
payments to physicians are not cut drastically.
Madam Speaker, I urge my colleagues to support not only H.R. 5712 but
also the overall health of many struggling Americans. I am an avid
supporter of health care reform and I stand today in steadfast support
of providing affordable health care for all Americans. However, if
doctors are unwilling to accept patients with Medicare because they
fear they will not receive payment for their services we face a serious
dilemma. It is our duty as legislators to provide such payment
guidelines for the legislation intended to provide affordable quality
health care for all Americans to ensure that it achieves is purpose.
In the final physician rule, Centers for Medicare and Medicaid
Services modified the MPPR policy to apply a 25 percent reduction,
rather than the proposed 50 percent reduction to physicians Medicare
payments. While that reduction shows movement in the right direction,
any reduction will hinder doctors' ability to effectively treat
patients who need their care the most like children and the elderly.
I ask my colleagues to please join me in supporting H.R. 5712, the
Physician Payment and Therapy Relief Act of 2010.
The SPEAKER pro tempore. Without objection, the gentleman from
California (Mr. Herger) will control the time.
There was no objection.
Mr. HERGER. I yield myself such time as I may consume.
Madam Speaker, for the fifth time in the last year, Democrats'
ability to properly manage the Medicare program is causing medical
doctors to confront a looming massive cut in their Medicare
reimbursement rates. In fact, when the cut went into effect in June,
Medicare held physicians' payments for weeks, and it ultimately was
forced to pay claims that cut physicians' rates by 21 percent, only to
later send additional payments once the majority congressional
Democrats decided to pass another patch. In practical terms, this meant
for weeks doctors and other providers saw no or greatly reduced
Medicare payments, but yet they still had to pay their rents, payrolls,
and other overhead expenses.
Madam Speaker, this is unacceptable and irresponsible. As a result of
the Democrats' failure to address this issue in a timely manner, tens
of millions of taxpayer dollars were wasted to reprocess physicians'
claims and to send new checks to doctors all because the majority party
could not finish its work on time.
Physician practices, like most small businesses, are hurt by this
dereliction of duty. In a letter signed by 117 physician specialty and
State medical societies, physicians detailed how many practices were
forced to seek loans to make payroll expenses, to lay off staff or to
cancel capital improvements and investments in electronic health
records and other technology. Furthermore, when payments resumed, many
physicians experienced long delays in receiving the retroactive
adjustments. The physician group letter states, ``This is not the way
to manage a program that seniors and the disabled rely on.''
The legislation before us provides for a 1-month postponement of the
23-percent cut; but in 1 month, the cuts return, this time even deeper,
with payment cliffs expected to reach nearly 25 percent on January 1.
Madam Speaker, the Democrats' practice of missing deadlines, of
withholding payments and reprocessing Medicare claims is no way to run
the program. Furthermore, the Democrats' new health law cuts more than
one half trillion dollars from Medicare but spends nothing on fixing
the physician payment problem. It is one of the many reasons we should
replace that flawed legislation with reform Americans can afford and
that we should address a true long-term fix for our doctors and
seniors. A Republican House will run this program differently.
We cannot miss deadlines. We must ensure doctors get paid on time for
the services they provide. We cannot string them along not knowing from
one month to the next what they will be getting paid by Medicare. As
doctors are making decisions about whether or not to participate in
Medicare next year, I want them to know that a Republican House will
not leave them twisting in the wind as they have been this past year.
Madam Speaker, I reserve the balance of my time.
Mr. PALLONE. I yield myself such time as I may consume.
You know, Madam Speaker, I was very upset to hear the gentleman from
California because I thought, for once--and it's very rare around
here--as I heard the gentleman from Oregon suggest that he was
supporting this bill, that we finally had some bipartisan support and
some Republican support for the SGR doctors' fix; but now I listen to
the gentleman from California, and he starts suggesting that somehow
the Democrats are to blame. Well, let me suggest that the opposite is
true.
Back in November of 2009, about a year ago, the Democrats in this
House passed a permanent fix. We wouldn't be here today if that
legislation had been supported by the Republicans. To his credit, only
one Republican--Dr. Burgess, who is a member of my Health
Subcommittee--did, in fact, support it, but he was the only one. It is
the Republicans' fault that we are constantly dealing with these short-
term fixes, because they don't want to take care of the doctors. They
don't want to resolve this, and they refused to come to the table and
resolve it with us while we were in the majority.
I don't want to go into it too much today because I know there is
support on the Republican side of the aisle for this 60-day fix, until
December 30; but in talking about the Democrats when the Republicans
are the reason we are here today because they would not support the
permanent fix and make it so that we didn't have to constantly go back
to the table, I think it is totally inappropriate for the gentleman of
California to lay blame when, in fact, it is his own party that is to
blame.
I reserve the balance of my time.
Mr. HERGER. Madam Speaker, I would like to mention to my friend, the
gentleman from New Jersey, that the legislation he speaks of, which
they offered, had a $200 billion, non-paid-for bill on that. We have to
begin living within our means, and through our legislation that we will
be offering, we will be working to do that.
I reserve the balance of my time.
Mr. PALLONE. Madam Speaker, I ask unanimous consent that the balance
of my time on the majority side be controlled by Representative Stark
of the Committee on Ways and Means.
The SPEAKER pro tempore. Without objection, the gentleman from
California will control the time.
There was no objection.
Mr. STARK. Madam Speaker, I yield myself such time as I may consume.
Before I start, I just want to comment that my distinguished
colleague from northern California, on the other side of the aisle, can
be so mean and so tough but, Madam Speaker, in a very gentle, pleasant
way. I do so look forward to working with him in the next Congress to
see how he is going to slap me around as we proceed to try and keep
physicians paid and to keep Medicare the great program that it is.
I rise in support of H.R. 5712. The legislation as we know, Madam
Speaker, provides for a 1-month extension. By extending current law in
this manner, we put SGR reform on the same timetable as other Medicare
provisions we need to renew before the end of the calendar year.
Without this bill, as we have heard from doctors and other health
providers, they will see their Medicare payments cut by 21 to 23
percent, and that is not acceptable.
[[Page H7621]]
{time} 1430
It's a bad outcome for physicians, for patients, for the government.
The only other solution would be for the Medicare agency to hold
payments until longer-term SGR reform legislation is enacted in
December, and that really plays hard with their practices. It is
difficult for them to plan, to pay their employees, pay their rent, and
know that payments will be postponed for 1 month.
So I join with my distinguished colleague across the aisle in
supporting H.R. 5712 and asking my colleagues to support it this
morning.
Mr. DINGELL. Madam Speaker, I rise today to acknowledge my support of
the one month patch to the Sustainable Growth Rate, but to state once
again, that we cannot continue to kick this can down the road. I
continue to support a permanent fix to the flawed SGR formula, like the
one we passed in the House of Representatives last year. I also want to
express my continued frustration that the Republicans in the United
States Senate thwarted them from following the House's lead on this
sound policy.
It is necessary that we pass this one-month extension today, but it
is far from sufficient. Two weeks ago, I introduced H.R. 6427, the
``Medicare Physician Payment Update Extension Act.'' This legislation
will extend the current physician Medicare reimbursements for 13
additional months. I believe this longer extension will give our
seniors and physicians the peace of mind they need while Congress works
on a permanent solution to this longstanding problem.
Tonight we will pass a one-month extension to ensure that seniors
have access to the same doctors they do today, and so doctors will be
fairly reimbursed for their services over the next month. However, when
we come together to address this problem again in 30 days, I urge my
colleagues to pass a permanent solution, or at minimum, pass a year
long extension so that we can ensure some stability to the Medicare
program.
Mr. CONYERS. Madam Speaker, I rise today in strong support of H.R.
5712, ``The Physician Payment and Therapy Relief Act of 2010.'' One of
the most important priorities of Congress, regardless of our current
economic downturn, is the financial well-being of our Nation's
hospitals, and the ability of patients to have access to medically
necessary care when they need it.
Passage of H.R. 5712 accomplishes both goals by blocking the 23
percent cut in Medicare payments to doctors, for one month, while
Congress and the Obama Administration work together to put together a
permanent fix to ensure the optimal Medicare reimbursement rate to
doctors and hospitals.
In order to have world class hospitals in the United States, we must
have the needed funding to ensure that our Nation's hospitals can
provide the highest quality care possible. Passage of H.R. 5712 will
help strengthen our Nation's hospitals, especially those located in our
inner cities and rural areas. Many of these hospitals are experiencing
serious funding shortages, and are at risk of losing much needed
doctors and medical staff.
H.R. 5712 is a bipartisan bill that costs one billion dollars, and is
fully paid for. This legislation helps to protect access to doctors for
Medicare beneficiaries and military families, given that payment rates
for doctors in TRICARE, the health care program for active-duty service
members, National Guard and Reserve members, military retirees, and
their families are tied to Medicare rates.
H.R. 5712 is a good example of how Members of Congress working
together in a spirit of bipartisan unity can improve the health and
well being of all Americans. I encourage my colleagues to support the
bill.
Mr. VAN HOLLEN. Madam Speaker, I rise in support of legislation that
would avert a 23 percent payment cut for Medicare physicians and
continue to provide them with a 2.2 percent update through December 31,
2010.
While I would like to see a permanent, long-term solution to the
flawed Medicare physician payment formula, this stop-gap legislation is
necessary so that Medicare beneficiaries can continue to see their
doctor of choice and have access to the care they need. However, a
long-term solution to this problem is needed to provide stability for
physicians who provide services under Medicare so that their practices
can adequately plan for the expenses they incur for treating Medicare
beneficiaries. In fact, the House passed legislation this Congress that
would have permanently fixed the Medicare physician payment formula.
Unfortunately, it was blocked in the Senate.
Madam Speaker, I hope our Republican colleagues will join us in
finding a long-term solution to this problem. I urge my colleagues to
support this legislation.
Mr. STARK. Madam Speaker, I yield back the balance of my time.
Mr. HERGER. Madam Speaker, while I intend to support this bill and
urge its passage, our work does not end here. We must find a long-term,
stable and fiscally responsible solution to this problem.
Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from New Jersey (Mr. Pallone) that the House suspend the
rules and concur in the Senate amendments to the bill, H.R. 5712.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the Senate amendments were concurred in.
A motion to reconsider was laid on the table.
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