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A last-minute, high-stakes debate over Medicare reimbursement rates

By Alec MacGillis
A long-running tussle in Congress over regional Medicare reimbursement rates has erupted into a last-minute clash that has at least one House Democrat threatening to withdraw his support for the health-care overhaul up for a vote Sunday.

At the heart of the dispute is an attempt by hospitals and doctors in areas with lower per-patient Medicare spending -- mostly in the Upper Midwest and Northwest -- to reform the Medicare payment system to reward the "high-value" care that they practice, which they argue would help reduce health-care spending over the long run.

After lobbying by a group of hospitals that includes the influential Mayo Clinic, the House bill that passed in December included language that would direct the Institute of Medicine to come up with a new Medicare payment system that rewards the "high-value" hospitals with lower per-patient Medicare costs, and penalizes those with higher per-patient spending.

Hospitals with higher per-patient spending rates -- which are disproportionately clustered in the South and in big cities like Los Angeles, New York, and Miami --- argued that the new payment system would unfairly penalize regions where spending is higher mainly because there are more poor and minority patients, who have costlier medical needs, in the patient base. The "high-value" hospitals also tend to charge high rates to insurers, canceling out some of the savings achieved by their lower-volume care.

The Senate bill included language to reform Medicare spending as well, directing the Department of Health and Human Services to come up with a new "value index" that would reward low-spending providers.

But the "high-value" hospitals prefer the House language, thinking it goes further. And their allies in the House are upset to discover that the final version of the legislation unveiled Thursday includes the Senate language, not the House terms.

They are also upset that the final bill does not include language from the House bill that tweaks the existing Medicare formula to immediately increase payment rates for the Upper Midwest, Northwest and other less-populated regions.

Rep. Peter DeFazio, a liberal Democrat from Oregon, told The Post Friday that unless congressional leaders restore the House language on Medicare payments, he will vote against the bill. "I will oppose the bill unless they fix geographic disparity," he said.

"If they need my vote, they can address it...." he said. "We can shovel money into Louisiana, but our fix is gone ... because there are some powerful East Coast senators who don't want it in there."

Rep. Ron Kind, a Wisconsin Democrat who is one of the low-spending "high-value" hospitals' strongest allies, said the issue was a cause of great concern for him and his colleagues, though he did not go as far as DeFazio and suggest he'd oppose the bill.

Other allies of the "high-value" hospitals include Rep. Bruce Braley (D-Iowa), Rep. Betty McCollum (D-Minn.) and Rep. Jay Inslee (D-Wash.).

Kind said the issue has yet to be resolved.

One option would be to restore the House language in the reconciliation bill. If it's too late to do that or if if the language is deemed unsuited to reconciliation, another approach would be to add the language to a separate manager's amendment. Congressional leaders are also talking to White House officials to see if the stronger payment reforms could somehow be brought about by the administration without legislation.

Congressmen from some of the higher-spending areas are fighting the attempt to add the more aggressive House language at the last minute, arguing that it would unfairly hurt their districts and do little to reform the system beyond sending more money to hospitals that are mostly doing fine as it is.

"We're looking for any possible vehicle or option right now," said Kind. "A lot of people feel passionate about this. We're making it clear to leadership we want progress on this."

By Alec MacGillis  |  March 19, 2010; 4:29 PM ET
Categories:  44 The Obama Presidency , Health Care  
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Next: Rhee turns to White House veteran Anita Dunn

Comments

Ok, it's time for the American military to step in, seize control of congress, arrest obama and biden, declare martial law, try obama and biden, execute obama and biden, then return the country to the American people.

Posted by: jhr1 | March 20, 2010 10:47 AM | Report abuse


... since all doctors are now govt employees under this bill... Posted by: docwhocuts

Liar. Or would you prefer, "You lie!"? This is your last gasp of desperation? Frauds passing themselves off as doctors with bald-faced misinformation like this? GTFO of here, stooge.

Posted by: washpost18 | March 20, 2010 10:18 AM | Report abuse

Obama is nothing more than a snotty teenager and spoiled brat, who is gleefully destroying our nation.


Posted by: Jerzy | March 20, 2010 9:59 AM | Report abuse

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Posted by: rritkonlyyou | March 20, 2010 9:52 AM | Report abuse

Obama is not our president, he's nothing more than a rotten con-man. Obama serves Saul Alinsky, not the people of America!
Obama stands before the country and utters lie after lie. Obama knows that America has rejected his health care bill. Obama does not care, he tells America we are too stupid to know what is good for us. Obama is a fanatic. Fanatics are not mentally stable or balanced. Obama must go now, not in three more years. America cannot survive Obama's fanatical corruption of shoving into law illegal bills against the will of the people of America.
Good, honest Democrats are leaving their jobs because they cannot allow Obama to threaten them into voting against their own conscience. Good lawmakers cannot abide this presidency and must leave before Obama destroys their reputations and good names.
Obama has dirtied the presidency of our country.

Posted by: prossers7 | March 20, 2010 5:40 AM | Report abuse

No, fascists.

Posted by: annnort | March 20, 2010 2:53 AM | Report abuse

Medicare will collapse on its own weight unless we start to add younger groups to this old insured pool. It's a bad idea to pool together only old people for health insurance purpose.

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Posted by: rritkonlyyou | March 19, 2010 11:47 PM | Report abuse

...the House bill that passed in December included language that would direct the Institute of Medicine to come up with a new Medicare payment system that rewards the "high-value" hospitals with lower per-patient Medicare costs, and penalizes those with higher per-patient spending.
---------------------------

Can you say RATIONING? Kill off the old folks sooner, they cost too much money! That's the Obomanation...

Posted by: j9zig1 | March 19, 2010 11:04 PM | Report abuse

The House is calling an emergency meeting of the Rules Committee tomorrow at 10 AM Washington time.

This is the first step in the Slaughter Solution.

NO OBAMACARE!

Posted by: michaelniland | March 19, 2010 11:01 PM | Report abuse


If you decide not to buy Obamacare, the federal government will TAX YOU 2.5 percent of your income every year. For a family making just under $250,000 a year, that is $6,250 in new taxes.

Barry the lying weasel Obama promised that families making under $250,000 would not pay one single dime in new taxes.

Posted by: screwjob11 | March 19, 2010 10:54 PM | Report abuse

Whoa! Seems this thing has kinda divided everyone... Leberals seem to think that passage of the legislation is going to bite corporate fat cats... Let's get real... Just a trillion dollars more is going to go into the coffers of the insurance industry... Who is going to pay? Taint a gunna be the rich who can afford to hold fundraisers for their favorite candidates... Taint a gunna be our manufacturing conglomerates who will just outsource more and more of our economy to the Chinese... Don't have to pay for health care for Chinese workers... We'll end up with health care and no jobs or food. Seems logical to me... Of course I could be wrong. The CBO says it will save 138 x 10^9 by such time and 1.2 x 10^12 dollars by another such time... I have total faith in the CBO... If it weren't for it looking out for us poor citizens, our country would most probably be in a helluva financial mess already!

Posted by: nemosnemesis | March 19, 2010 9:57 PM | Report abuse

I live in the 5th district in Oregon, about 2 miles from the boundary to DeFazio's district. So technically I am not one of his constituents. But please, Peter, get off the high horse! Don't hold this bill back. Don't be the next Ben Nelson. And please, Kurt Schrader, don't listen to Peter! Pass the bill, vote yes! Yes, yes, yes!!!

Go Democrats. Affordable health care for all Americans in 2010!

Respectfully,

F.M.

Posted by: Felipe_M | March 19, 2010 8:10 PM | Report abuse

Cut payments to doctors?

while the rest of the govt employees get raises... since all doctors are now govt employees under this bill... we need free health care, pensions at 50 years old, protection from termination..........

...... If obama wants a legion of govt employees... we will unionize and drag this industry down like all the others.

Or, we will do what our group did years ago... stop taking medicare/medicaid pts.

Posted by: docwhocuts | March 19, 2010 7:37 PM | Report abuse

Cut payments to doctors?

while the rest of the govt employees get raises... since all doctors are now govt employees under this bill... we need free health care, pensions at 50 years old, protection from termination..........

...... If obama wants a legion of govt employees... we will unionize and drag this industry down like all the others.

Or, we will do what our group did years ago... stop taking medicare/medicaid pts.

Posted by: docwhocuts | March 19, 2010 7:37 PM | Report abuse

Dateline - Washington D.C. December 28 2010 - - President Obama announced today that he is once again delaying his trip to Asia awaiting the final – no we really mean it this time – vote on health care reform. Speaker Pelosi has assured the President of victory since taking out contracts on 17 blue dog democrats with some guy named Vinnie from Philadelphia.

Film at 11:00

Posted by: sosueme1 | March 19, 2010 7:24 PM | Report abuse

It seems to me that urban hospitals have higher costs. Try moving from Portland to NYC and see what happens to YOUR spending.

Posted by: scientist1 | March 19, 2010 7:03 PM | Report abuse

I guess there's no last minute high stakes debate on the use of non professional gatekeepers to limit costs in the Bill's new Medicare policy? That's alright with every politician UNTIL constituents are told that they are too old for a kidney and their Representative pulls out the old Kerry imitation about being was against it before they were for it.

Posted by: thecannula | March 19, 2010 6:57 PM | Report abuse

Are there any thoughtful adults out there? My 12-year-old granddaughter could writer better and more coherent comments than I see here.

Please, name calling is done on playgrounds by children. Argue your point of view with relevant and checkable references.

But don't embarrass the both of us with sudh a childish display of name calling.

Posted by: littleoldlady | March 19, 2010 6:46 PM | Report abuse

Oh goody. The greedy are turning on themselves.
Raising the question: Can this plan buy all of the special interests all the time, or just some of the special interests all of the time?
At some point, political karma will come in to play.

Posted by: mtpeaks | March 19, 2010 6:31 PM | Report abuse

RealTexan1: no, this is how legislation has been done since our founding fathers. where have you been?

Posted by: JoeT1 | March 19, 2010 6:15 PM | Report abuse

Troll Memo

Posted by: osullivanc1 | March 19, 2010 6:14 PM | Report abuse

Oops sorry for offending Facists. Just democracy at work, Fascists!

Posted by: dug2008 | March 19, 2010 5:54 PM | Report abuse

No, just democracy at work, Facist!

Posted by: dug2008 | March 19, 2010 5:52 PM | Report abuse

Wonder what Newt Gingrich would do?

Wonder what Tom Delay would do?

Wonder what Dick Armey would do?

Wonder what Dick Cheney would do?

Wonder what George Bush would do?

Wonder what Mich McConnel would do?

Wonder what John Boehner would do?

Posted by: Geopolitics101 | March 19, 2010 5:15 PM | Report abuse

Oh dear, trouble in Utopia, socialists?

Posted by: RealTexan1 | March 19, 2010 4:59 PM | Report abuse

The comments to this entry are closed.

 
 
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