From now through the end of the year, lawmakers can look forward to hearing from physicians, family practitioners, nurses, home health workers and anyone else who provides care to patients.
On Nov. 29, four hospital executives held a briefing in the Rayburn House Office Building, while members of the American Academy of Orthopaedic Surgeons visited Capitol Hill. More such events by a variety of medical professionals are planned in the coming weeks.
The visits are part of separate, but equally intense, efforts by health care groups to protect their members from potential Medicare payment cuts, especially in the ongoing deficit-reduction negotiations.
“AAOS is headed to Capitol Hill to ensure that our patients’ interests are communicated to our policymakers during these negotiations,” John Tongue, president of the orthopedic surgeons group, said in a statement. “Patient choice and patient access to care could be significantly restricted if responsible decisions are not made during this fiscally uncertain time.”
December brings what health care providers are calling “death by a thousand cuts.” Not only are they at risk for reductions from the impending sequester or an alternative deficit reduction deal, but several current payment provisions are set to expire at the end of the year. And then there’s the annual concern over what has come to be known as the “doc fix,” an effort to avoid a scheduled cut in Medicare payments to doctors according to a formula set in 1997.
Absent congressional action on any of these issues, many health care providers would see significant cuts in their Medicare reimbursement rates.
Making the situation even more complicated is that providers are not lobbying as a united force, because what’s good for one group may not work for any others. For example, although all of the groups want to prevent cuts in Medicare reimbursement rates for physicians, the most recent doc fix (PL 112-96) was paid for in part by cutting payments for hospitals, skilled nursing facilities and clinical labs.
“We worry about further cuts in payments to hospitals and other caregivers as a way to offset some of these provisions or to be part of one of the spending reduction deals,” said Rick Pollack, executive vice president for advocacy and public policy at the American Hospital Association. “From our perspective, we can’t take any more reductions, and the result is going to be real issues relating to being able to provide access to care.”
Although the groups share common goals, at the end of the day each one has to lobby for itself. That’s why many are ramping up efforts this month to make their cases to Congress.
The AHA held a “fly-in” to bring hospital leaders from around the country to Capitol Hill on Nov. 29, and it has another event planned for Dec. 11. The group is running ads and plans to release a series of studies showing the effect the cuts would have on providers and on patient access. In addition, it is pushing a campaign for hospital workers to contact their representatives.
“Grass roots is obviously always king,” Pollack said. “We have hospitals in every congressional district in America that need to be working on this on that end as well.”
The AHA is particularly concerned about once again facing payment cuts to help offset the cost of the next doc fix — the one-year patch to stop an almost 27 percent cut in Medicare provider reimbursements beginning Jan. 1.
The group worries that Congress will use a recommendation from the Medicare Payment Advisory Commission to cap payments for services performed in hospital outpatient departments at the usually lower rate paid for those services when they are performed in physicians’ private offices.
Erik Rasmussen, senior associate director at the AHA, said the commission’s goal of moving services to less expensive places is “not a bad idea.” But, he added, hospitals are already underpaid, and the recommendation would reduce hospital payments up to 80 percent for the 10 most common outpatient services.
“We support the docs getting fixed,” Rasmussen said. “But we’re concerned — this is not the way for the payments to get fixed.”
The American Physical Therapists Association is also homing in on specific items, worried that the high-profile negotiations around the fiscal cliff will overshadow other issues.
“It’s our responsibility to make sure that some of these long-standing beneficiary- focused, rehabilitation-focused things aren’t lost in all that static,” said Justin Moore, the group’s vice president of government and payment advocacy.
The physical therapists’ goal is to extend an exceptions process for the Medicare cap on payments to various outpatient therapy services, including physical, occupational and speech and language therapy. The exceptions process, one of the “Medicare extenders,” was extended earlier this year, in the same package that included the doc fix.
Without action, the exceptions process that allows patients to get covered care above a certain amount will expire, said Moore, meaning that patients will have to pay more for the same amount of care.
More than 50 patient groups are lobbying on a variety of budget issues, including lengthening the therapy-caps-exception process, as part of a “30 Days to Deadline” activity this week.
“We’re doing a lot to try to put the patient face on the therapy cap issue specifically,” Moore said.
Other groups are taking a wait-and-see approach. Chip Kahn, president of the Federation of American Hospitals, says his group is focused for now on what comes out of the deficit talks between the White House and congressional leadership.
Although the group is concerned about extending expiring payment provisions for rural hospitals, as well as the doc fix and its offsets, the big deficit reduction deal could affect some of those smaller issues, he said.
“All those things are important, but the big picture is going to set the tracks,” Kahn said. “We have to approach the thing probably a little bit differently than some of the groups ... that are really one-issue groups.”
Because Medicare is such a big part of the federal budget, it will almost certainly be part of any deal to reduce government spending, Kahn said. And because hospitals account for 35 percent to 40 percent of Medicare spending, they are sure to feel some of those cuts.
“You always have to be concerned where there’s this nexus between fiscal policy and health policy. Fiscal policy is going to drive health policy, and not necessarily what the best health policy is,” Kahn said.