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In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21.3% reduction in Medicare reimbursement to physicians and other health providers.

 A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.

 The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30, rather than for the 19 months mandated by the earlier bill.

 It still was not enough, however, to win over the 60 senators needed to end debate on the issue under Senate rules. Fifty-six senators voted in favor, with 40 opposed. Opponents argued that the overall measure was not offset by spending cuts and added too much to the deficit.

The pay cut for physicians took effect June 1, but the Center for Medicare and Medicaid Services (CMS) had held up June claims through today, anticipating that Congress would stop the reduction retroactively.

 Because the "doc fix" was defeated, CMS is ready to authorize its contractors to begin paying physicians at the lower rate.

 "Senate Fiddles as Medicare Burns"

 The American Medical Association (AMA) warned that unless Congress restores the cuts, physicians will limit the number of Medicare patients they treat. A survey of 9000 members revealed that 17% of physicians — and 31% of those in primary care — would take such action because Medicare rates are too low.

 Just before the vote, when the 6-month fix was still seen as viable, the AMA condemned it, saying that Congress has broken its promise to America's seniors and military families. In a news release titled, "Senate Fiddles as Medicare Burns," AMA President Cecil B. Wilson, MD, noted that Congress has been arguing about the "doc fix" for months.

 "Delaying the problem is not a solution," Dr. Wilson said in the statement. "Continued short-term actions are creating severe instability that harms seniors as physicians make decisions to protect their practices from Medicare's volatility. Continuing down this path just slaps a Band-Aid on a problem that needs urgent surgery."

Authors and Disclosures


Mark Crane, BA

Freelance medical writer, Brick, New Jersey