Have your cake and eat it too -- if new bill passes
Have your cake and eat it too if new bill passes
Changes to private contracting bill proposed
After a hard-fought battle, physicians won the right to enter into direct contracts with seniors for medical services outside of Medicare. This change came with a catch, however. Once physicians sign such contracts, HCFA will not pay them for any new Medicare claims for two years.
The direct contracting provision, passed as part of last summer’s budget bill, goes into effect in January.
Legislation that would repeal this two-year HCFA reimbursement ban is gathering momentum. The House GOP leadership solidly supports the measure, while Assistant Senate Majority Leader Don Nickels (R-OK) is a co-sponsor of the Senate companion proposal.
And as Physician’s Payment Update went to press, the New York Times reported that Sen. Jon Kyle (R-AZ) was attempting to pass a bill that would allow physicians to privately contract with patients without being barred from the Medicare program for two years, as is currently required. The kicker to Kyle’s request, according to the Times, was a threatened ban on approving the nomination of Nancy-Ann Min DeParle as the new administrator of HCFA until the two-year ban was eliminated.
Supporters argue that the bills simply give seniors the option of using their own money to pay for Medicare services, if they choose.
Opponents point out that seniors already in fee-for-service plans can voluntarily disenroll from Part B to pay out of pocket for physician services. Detractors also argue that the legislation which, for the first time, allows physicians to choose between writing private contracts for services or providing them under Medicare’s rules and fee schedule effectively wipes out existing balance-billing safeguards.
Opponents also contend that enacting this change could make it easier to commit Medicare fraud. This is because double billing, in which providers bill patients for services that HCFA is paying for through capitation, could be hard to pinpoint.
Informational materials prepared by the AMA being circulated to lawmakers maintain that seniors "who did not want to enter into or continue a private contract could simply switch to another physician or choose a plan with different financial arrangements." Senior advocacy organizations counter that the majority of seniors, whose annual income is under $20,000, would not be able to switch plans easily.
The AMA also says private contracting legislation could improve access to specialty care, "because physicians will be more inclined to treat Medicare patients if they see the program rules as reasonable and rational." On the question of charges, AMA argues that "physicians opting for private contracts will still face significant legal and ethical constraints on their billing practices."
At an Oct. 9 hearing of the House Ways & Means Health Subcommittee, Rep. Ben Cardin (D-MD) noted, "I don’t know of any insurance company that would allow its doctors" to receive both a capitated payment and additional fees paid by subscribers for discrete services. Rep. Pete Stark (D-CA) said doctors can already set their own fees for services not covered in Medicare’s benefits package.
At an Oct. 8 press conference, Stark observed that there are no data that show problems of access due to Medicare paying doctors too little. "In fact, the biggest access problem is seniors’ reluctance to see a doctor because the 20% copay costs too much," he asserted.
But, according to Rep. Jim McCrery (R-LA), if private contracting legislation fails to pass, wholesale rationing of services will occur over the long run. In contrast, the American Association of Retired Persons has argued that rationing of services could increase if doctors are permitted to charge fees that are significantly higher than Medicare’s fee schedule.
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