Washington Health Policy Week in Review

Washington Health Policy Week in Review is a weekly newsletter that offers selected stories from the daily newsletter CQ HealthBeat.

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Stark Ho-Hum About Erasing Doctor Payment Cut

By John Reichard, CQ HealthBeat Editor

December 1, 2006 -- Incoming House Ways and Means Health Subcommittee Chairman Pete Stark shed crocodile tears Friday for many of the physicians facing a 5 percent cut in Medicare payments Jan. 1, saying he tries to relate to their suffering, but can't quite pull it off.

The California Democrat expressed indifference about the issue at a Washington, D.C., conference as congressional aides in both chambers of Congress tried to put together a deal that would block the cut.

Stark intimated after the speech that the position of Democrats on the issue may not matter much to its outcome in the lame-duck session of Congress that resumes Dec. 4. But his lack of a sense of urgency about the cut may become more significant if dealing with it is put off until next year.

"I don't know what the Republicans plan to do in the lame-duck session about the cut," Stark said in Q&A after a speech to the meeting, which was sponsored by the National Committee for Quality Assurance. But he said he personally is having a hard time finding a "proceduralist" whose income is actually declining.

"What we're finding is that they got about a 10 percent increase in gross fees," he said. "Now maybe they're giving up their golf games, maybe their upcoding more than I think they should be, but . . . the total income has gone up," he said. "So I should feel sorry?"

Stark mused that "if they have higher productivity, maybe we ought to cut the price a little bit." He allowed as how he'd read recently that top radiologists at a hospital in Indianapolis were making annual incomes between $490,000 and $620,000 a year. "It's hard for me to suffer with those people, you know?" Stark told tittering audience members. "I just try . . .," he said without completing the thought, the audience erupting in nervous laughter.

Stark voiced more sympathy for pediatricians, internists, and family practitioners, but said, "I just think this is the AMA trying to shake down their membership for more fees."

For those unaccustomed to Stark's routine skunk-at-the-garden-party potshots, his remarks might seem to bode ill for blocking the cut, but he shied away after the speech from saying he'd let it take effect. Stark said that if the issue were put off until next year, he might not erase it entirely. But when asked if that meant he would allow a small cut to take effect, Stark wouldn't be pinned down.

If Stark's remarks rankled doctors, they probably weren't alone. Incoming House Speaker Nancy Pelosi, D-Calif., may not be thrilled with Stark's prediction that the House Democratic health agenda "may be more modest than most people think."

"We have some priorities that were set by our campaign rhetoric, and I suspect that we are going to try very hard to perform on those," he said. Stark said he expected that Pelosi during the first 100 hours of the new Congress would offer bills ending the prohibition on allowing the Department of Health and Human Services to negotiate Medicare prescription drug prices and widening research on human embryonic stem cells.

"At the rate the far right of the evangelical church is disintegrating, we'll probably get the stem cell research through pretty quickly," he quipped. "As for drug price negotiation, I much don't care which way they do it, my guess is they just knock the prohibition out and we'll see what happens, but that will be decided by the leadership at a higher pay scale than mine."

But he added that legislation creating a government-run Medicare drug plan to compete with private plans might be too "radical" to avoid a presidential veto. "I don't look at that as very likely," he said of the legislation. And concerning a top Democratic priority, he added in passing, "I don't think that we can eliminate the doughnut hole"—referring to the coverage gap at which beneficiaries must pay out of pocket for drug costs between $2,250 and $5,100.

"Beyond the negotiating authority, I think there are some minor changes we could make to the Part D program," Stark said. Among the possibilities he listed were changing the penalty for late enrollment in Medicare, limiting the ability of Medicare drug plans to make coverage changes during the year, and possibly changing the asset test required to qualify for the low-income Medicare drug benefit.

Stark added that "we could equalize" payments to Medicare managed care plans, saying in effect that they could be trimmed to be equal to fee-for-service payment levels. And he predicted that his committee would perform oversight hearings, saying there had been "no real oversight hearings in the last six years."

Stark said he didn't know whether the Centers for Medicare and Medicaid Services would be more forthcoming than it has been in the past to his information requests. "When they do give us information we request, which is seldom, they often lie," he said. "Maybe that will come to an end."

Stark's hosts at the event were not spared his in-your-face assessments. NCQA is a leader in developing performance measures to assess the quality of care, but Stark said that he wanted to make clear his views on tying Medicare payments to performance on quality measures, an objective of the Bush administration and of many on Capitol Hill.

"My staff wanted me to be sure that I said this right," he said. "The entire concept of pay for performance is offensive. We shouldn't ever expect anyone to get paid more for doing what they were . . . paid to do," he said. Medicare "must demand the highest quality and no less." Quality should be expected "from each and every provider. And my solution would be to the provider who can't provide quality care, to defrock 'em."