[Congressional Record (Bound Edition), Volume 152 (2006), Part 12]
[House]
[Page 16087]
[From the U.S. Government Publishing Office, www.gpo.gov]




 TACKLING THE IMPOSSIBLE? LAWMAKERS ADDRESS PHYSICIAN PAYMENT OVERHAUL

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent to speak out of 
order for 5 minutes.
  The SPEAKER pro tempore. Without objection, the gentleman from Texas 
is recognized for 5 minutes.
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I come to the House floor tonight to talk 
to my colleagues about a bill, H.R. 5866. This is a bill that will 
repeal the SGR, the formula by which physicians are paid under 
Medicare, and replace it with a more sustainable, more market-friendly 
Medicare economic index which in fact reflects the actual costs of 
input for the physician delivering the care.
  Mr. Speaker, the Medicare Physician Payment Reform and Quality 
Improvement Act of 2006 has four main goals: First, to ensure that 
physicians receive full and fair payment for services rendered; 
secondly, to create quality performance measures that allow patients to 
be informed consumers when choosing their Medicare provider; thirdly, 
to improve Quality Improvement Organization accountability and 
flexibility; and, fourth, to find reasonable methods of paying for 
these benefits.
  Current law calculates an annual update for physician services based 
on the sustained growth rate, or SGR, as well as the Medicare economic 
index and the adjustment to bring the MEI update in line with the SGR 
target. When expenditures exceed the SGR target, the update for a 
future year is reduced. If expenditures fall short, the update for 
future years is increased. This is an economic incentive for physicians 
to limit health care spending.
  Unfortunately, Mr. Speaker, the system simply doesn't work. 
Healthcare spending continues to grow and physicians exceed their 
target expenditures every year. Subsequently, Medicare reimburses them 
less and less. The net result is that patients have less and less 
access to their physicians, and those patients covered by Medicare 
arguably are our nation's most frail and complex patients.
  This bill just introduced ends the application of the SGR January 1, 
2007. Instead, we propose using a single conversion factor for Medicare 
reimbursement: The MEI, Medicare economic index, minus 1 percent. This 
eliminates the negative feedback loop that constantly creates a deficit 
in healthcare funding and introduces a more market sensitive system.
  Regarding quality measures, the American Medical Association and 
other physician organizations have been working to create a relevant 
evaluation system for outpatient healthcare. In conjunction with these 
organizations, we propose creating a voluntary system of evidence-based 
quality measures.
  Each physician specialty organization will create their own quality 
measures applicable to core clinical services which they will submit to 
a consensus building organization. Taken as a whole, these measures 
should provide a balanced overview of the performance. They will allow 
patients to better understand the quality of the healthcare providers 
they choose and be a fair assessment to reduce healthcare disparities 
across groups and regions. This will arm patients with critical 
information related to quality of care giving and give physicians a 
yardstick to measure their own performance and make improvements.
  Additionally, these provisions largely follow the spirit of an 
agreement brokered between medicine and leaders on the Hill when 
finalizing negotiations on the Deficit Reduction Act.
  To offset the cost of these changes, we are looking at multiple 
options: Redirecting the stabilization fund from the Medicare 
Modernization Act provides some funds. Also Medicare currently pays for 
indirect costs of medical education twice, directly and by inflating 
payments to Medicare Advantage plans. By paying only once, we can find 
additional money.
  Mr. Speaker, I would submit that there are other cost saving measures 
that can be employed, and we are certainly encouraging many groups 
across the healthcare spectrum to partner with us on this.
  A recent article in CQ Healthbeat News from January 25th talks about 
the changes that might occur in the SGR. We had a hearing on Tuesday. 
The article says, ``Tuesday's hearing may have marked progress of 
sorts, because not only were lawmakers at least talking about what was 
seemingly an intractable issue, but they actually offered some ideas 
for a down payment on a long-term fix.
  ``Offering a road map on the issue was legislation, H.R. 5866, that 
would erase the scheduled payment cuts while arming Medicare 
beneficiaries with more information on the quality of physician care.
  ``The bill would lower the MEI by 1 percentage point, which in 2007 
would mean a payment increase of 2.7 percent. The Medicare Payment 
Advisory Commission called for an update based on the MEI of 3.7 
percent in 2007 minus an adjustment fact of 0.9 percent, essentially 
the same number.
  ``The bill would also enact recommendations by the Institute of 
Medicine to improve Quality Improvement Organizations which contract 
with Medicare to improve quality of care under the program. The bill 
would make the quality improvement activities of QIOs available to all 
providers, guarantee a minimum of funding for QIOs and a required 
review of their resources when the organization's duties are 
expanded.''
  Mr. Speaker, I think this is a worthwhile bill. I think this Congress 
owes it to the patients and the physicians in this country that depend 
upon the Medicare system. We have done some great things with expanding 
the prescription drug program, but it is time to address some of the 
other shortcomings of the program.

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