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Baucus Seen Sympathetic Toward Primary Care 'Bump'

By John Reichard, CQ HealthBeat Editor

April 11, 2008 -- Senate Finance Committee Chairman Max Baucus, D-Mont., wants to boost payments to primary care physicians in the physician payment package he aims to take to the Senate floor in mid-May, lobbyists say.

The Medicare Payment Advisory Commission (MedPAC) approved a recommendation this week that Congress make an "adjustment" in Medicare payments for primary care services, calling for an unspecified payment increase lobbyists are calling the primary care "bump."

The advisory commission is concerned that the Medicare program and the nation generally will increasingly face a shortage of internists and family practitioners who provide basic medical services. MedPAC analysts believe that having an ample supply of such primary care physicians is one of the keys to improving U.S. health care. If each patient has such a physician, their treatment is more carefully supervised, improving preventive care and eliminating duplicative testing, analysts say.

Because salaries are relatively low, fewer and fewer medical students are choosing to go into primary care, even as the need for such physician grows, MedPAC analysts noted this week.

But the MedPAC recommendation says the adjustment should be "budget neutral," meaning that any increase in payments for primary care services must be offset by commensurate decreases in payments for specialty care.

Specialty group representatives at a meeting with Baucus Friday on his physician payment proposal balked at taking a hit under budget neutrality.

Medicare has previously made some budget-neutral payment changes to narrow the wide gap in reimbursement for primary versus more lucrative specialty care. The reaction of several specialty groups was that "'we have paid several times for different things and we don't want to pay for it,'" one lobbyist said.

Baucus may face a delicate enough task negotiating the physician payment package, which he hopes to take directly to the Senate floor in mid-May, without also having to resolve further disagreements within the medical profession over specialty versus primary care. Baucus has said he does not plan to mark up the physician measure in the Finance committee.

The package he outlined Friday calls for an 18-month postponement in scheduled Medicare payment cuts to doctors along with an across-the-board increase in payments to doctors of 1.1 percent during that period. It's unclear whether he can find payment offsets to fund the package, however, and Baucus refused to discuss potential "pay-fors" at the meeting.

Baucus excluded the American Medical Association from the meeting Friday, saying he wanted to encourage candor on the part of other medical groups that have not always agreed with the AMA.

When asked for AMA's reaction Friday to an 18-month package with a 1.1 percent increase, a spokeswoman for the medical organization said, "The AMA is committed to working with members of the Senate Finance committee, [Senate leaders], and key House members on both sides of the aisle to address important Medicare issues, and we applaud the desire to stop the Medicare physician payment cuts for 18 months. Key details are still under discussion, and we look forward to reviewing the complete Medicare physician payment package."

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