After the June 12 failure of a cloture vote on a bill aimed at preventing 10.6-percent Medicare reimbursement cuts to physicians, Republicans and Democrats in the U.S. Senate sought to reconcile the bill with competing legislation before cuts go into effect July 1. Sponsored by Republican Sen. Grassley and Democratic Sen. Max Baucus, respectively, S-3118 and S-3101 differ in their approaches to the budgetary fix required to update the program's strategic growth rate formula, but even their similarities will cause changes in quality reporting, e-prescribing, Medicare Advantage and other areas.

The bills are not related to the scheduled 10-percent cuts in California's Medi-Cal program.

The mid-June cloture vote on Sen. Baucus' bill failed to gain the 60 votes needed to begin debate in the chamber, with 54 voting in favor and 38 against. Although the vote could have succeeded with additional votes from five absent Democrats, Sen. Grassley and other observers point out that President Bush would have likely vetoed the bill.

The vote tally fell largely along partisan lines, with nine Republicans voting in favor of cloture. California Sen. Dianne Feinstein and Sen. Barbara Boxer both voted in favor.

Before the vote, Senate Majority Leader Harry Reid denied Republicans a cloture vote on the Grassley bill, which is similar to the Baucus bill in several respects. According to the American Medical Association, both would halt the 10.6-percent physician reimbursement cut on July 1 and the Jan. 1 cut of 0.5 percent, replacing them with increases of 0.5 percent until Jan. 1 and 1.1 percent from that date until the end of 2009.

Unfortunately, both bills would result in scheduling a 21-percent reimbursement cut for January 2010; each seeks to ameliorate that problem by requiring establishment of a fund in 2014, the AMA adds.

Both bills would extend the Physician Quality Reporting Initiative for two years, while providing a 2-percent bonus for reporting physicians in 2009 and 2010, says the AMA. The two bills also require the secretary of the U.S. Department of Health and Human Services to identify a consensus-based body to endorse new quality measures. The secretary would also be required to give doctors feedback on their resource use and create a plan in the next two years that transitions to a value-based purchasing program. The Centers for Medicare and Medicaid Services would be required under each bill to post on its website the names of physicians who correctly submit data on PQRI measures and e-prescribing.
Also, both bills provide incentives to encourage physician adoption of e-prescribing. Generally, physicians reporting PQRI e-prescribing measures for services making up 10 percent of their Medicare charges can qualify for bonus payments of 2 percent in 2009 and 2010, with lower bonuses of 1 percent for the next two years and 0.5 percent for 2013. Increasing penalties begin to take effect in 2012 and beyond for qualifying physicians who do not adopt e-prescribing.

Finally, the AMA notes that both bills would eventually end double payment to Medicare Advantage plans for indirect medical education. In a step toward reconciling Medicare and Advantage, the bills require MedPAC to develop performance and patient-experience comparisons between the plans by March 2010.