[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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