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Docs Push for Payment Fix, Medical Malpractice Overhaul

March 15, 2005—Hundreds of physicians assembled in Washington wanted to hear Bush administration officials and Capitol Hill lawmakers promise to fix scheduled cuts in Medicare payments to physicians and overhaul the nation's medical malpractice system.

That's exactly what they got last Tuesday at the Mayflower Hotel, but there was bitter with the sweet.
Speakers also warned that "pay for performance," an initiative that links Medicare payments to the quality of medical care delivered, is on the way, as are audits to make sure that Medicare is not improperly paying for medical services.

The biggest crowd pleaser at the American Medical Association gathering was the speakers' resolve to push legislation that would place a $250,000 cap on damages awarded for pain and suffering and limit the amount of fees that attorneys could collect in such cases.

The medical malpractice system is "spinning out of control further and further each day," Senate Majority Leader Bill Frist, R–Tenn., told the audience, urging them to make sure "your voices and the voices of your patients are heard in the halls of Congress."

AMA officials and many lawmakers, including Frist, contend that high medical malpractice insurance rates are forcing physicians to leave medicine, which in turn is hurting patients' ability to seek medical care.

Frist, one of two physicians in the Senate, has failed three times to pass his medical malpractice overhaul plan, and he lamented his lot to the AMA. "I'm a pilgrim in an unholy land," Frist said, referring to the Senate's 58 lawyers, many of whom oppose the GOP's medical malpractice proposal.

If Frist does not prevail, government officials are hopeful that a Department of Health and Human Services program aimed at encouraging settlements of patients who have alleged medical malpractice against their physicians will help cut litigation.

The "Early Offers" pilot program, which former HHS secretary Tommy G. Thompson announced last fall, applies to claims made against HHS by patients who are treated by employees of federally funded community health centers overseen by HHS' Health Resources and Services Administration or by patients who receive medical care through Indian Health Service programs, HHS said in a news release. Participation is voluntary.

Frist, as well as Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, addressed AMA members' concerns about Medicare payment cuts which are scheduled to begin next January.

McClellan said his agency is now evaluating an AMA proposal on how to change the formula Medicare uses to pay physicians, stressing that doctors are "the critical piece" in providing quality care to Medicare patients.

Frist said after his remarks that "it's too early to know" if Congress will pass either a one-year or a multi-year fix on Medicare physician payments, but he said it would be addressed this year.

Frist also told reporters physician payments as well as a "pay for performance" initiative for physicians could be addressed separately, rather than first reversing the scheduled cuts before linking any payments to performance, as some physicians have advocated.

"They're independent tracks," Frist said.

Separately, Rep. Nancy L. Johnson, R–Conn., urged her colleagues to "reward, not penalize, physicians"” as Congress considers changes in how Medicare pays doctors.

In a "Dear Colleague" letter sent to House members, Johnson wrote "emails, phone calls and other new forms of communications and health care delivery must be integrated into the payment system to help avoid medical care in costlier settings, such as nursing homes, hospitals and emergency rooms."

"The challenge is real in a tight budget cycle but to fail will erode seniors' access to the physician of their choice," Johnson wrote.

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