Summertime, and the Budget Is Squeezing

Abstract

Alot of people in Washington didn’t get the memo this year: Going into August, you’re supposed to slow down. Congress should take it easy, limit itself to National Funnel Cake Day resolutions and the like. But no, politics and government shifted into overdrive in late July, as the debt ceiling threatened to crush us all. As this column went to press, there hadn’t yet been an escape from the heat or default or the possible gutting of Medicare, Medicaid, and all things costly to the federal government. But the unfinished process spoke volumes about possibilities for future health and long-term care spending. It was a good news/bad news story on physician payments under Medicare and long-term care insurance. First, the bad, or at least the scary: The Centers for Medicare & Medicaid Services released its annual proposed fee schedule for 2012, and it made it official that Medicare physician fees are slated to be cut overall by 29.5% under the Sustainable Growth Rate (SGR) formula. AMDA’s government affairs department pulled the figures for nursing facility codes (99304-10, -15, -16, and -18) and showed that fees for physicians who care for nursing home residents could see an update of at least –12.1% (99316) and as much as –28.9% (99307), with most cuts being at the bigger end of that spectrum. That is, they’ll be that drastic if Congress doesn’t temporarily override SGR or permanently fix the physician payment system. Both bad and good news for many supporters of long-term care came up during the deficit-ceiling deal making. Staying with the potentially bad news first, the on-again, off-again (but influential deficit-cutting) “Gang of Six” senators stated bluntly that they would repeal the CLASS (Community Living Assistance Services and Support) Act, the long-term care insurance program created last year under the Affordable Care Act. Ironically, the President’s National Commission on Fiscal Responsibility and Reform (known as the Bowles-Simpson group) had estimated that preempting Summertime, and the Budget Is Squeezing By Keith Haglund