Government and Regulations

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Physicians and hospitals now have the chance to test out bundled payments on a range of conditions under a new Medicare initiative.

Officials at the Centers for Medicare and Medicaid Services have invited physicians, hospitals, and other health care providers to participate in the Bundled Payments for Care Improvement initiative. The program, which was mandated under the Affordable Care Act, offers a variety of options for bundling payments for a hospital stay, for post-discharge services, or for both the hospital stay and the post-discharge care.

The move toward bundled payments is a major shift in how the government pays for medical care. Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care for a specific condition. The aim of the program is to incentivize clinicians to work together and provide better continuity of care, resulting in better quality and lower costs.

"Today, Medicare pays for care the wrong way," Health and Human Services Secretary Kathleen Sebelius said during a teleconference to announce the bundling program. "Payments are based on the quantity of care, the amount of services delivered, not the quality of that care. And that leaves us too often with a system that actually can punish the providers that are most successful at getting and keeping their patients healthy."

The new bundling program offers four ways that health care providers can receive a bundled payment, three of which provide payment retrospectively, and one that offers a prospective payment. For example, under some of the retrospective payment models, CMS and the providers would agree on a target payment amount for the episode of care and providers would be paid under the original Medicare fee-for-service system, but at a negotiated discount of 2% to 3% or greater. At the end of the care episode, the total payment would be compared with the target price and providers would be able to share in the savings, according to CMS.

The prospective payment model would work differently. Under that option, CMS would make a single bundled payment to the hospital to cover all services provided during the inpatient stay by the hospital, physicians, and other providers. That payment would offer at least a 3% discount to Medicare. Under this option, physicians and other providers would submit "no pay" claims to Medicare and the hospital would pay them out of the single bundled payment.

In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care will be and what conditions they want to bundle payment for, and what services would be included in the payment. CMS officials said they wanted to make the program flexible so that a range of hospitals, physicians, and other providers could participate.

Organizations interested in applying must submit a letter of intent by Sept. 22 for Model 1 and by Nov. 4 for Models 2, 3, and 4. More information on the program and how to apply is seen at www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html.

Dr. Richard Gilfillan, the acting director of the CMS Innovation Center, which is overseeing the bundling initiative, said he expects that hundreds of organizations will apply. CMS will consider a number of factors in choosing participants for the program including the best proposals for care improvement, the number of patients involved, and the conditions addressed, and the price discounts offered, he said.

The program is a unique opportunity for hospitals to redesign their systems to promote better care coordination, Dr. Gilfillan said, and have that effort supported through Medicare payments.

The idea is to eliminate the traditional barriers between physicians and other providers – both inpatient and outpatient – all of whom may be involved in the care of a single condition, said Dr. Nancy Nielson, senior advisor to the CMS Innovation Center and past president of the American Medical Association. "I do believe that both physicians and hospitals will find this [to be] an opportunity that’s flexible enough to give them the opportunity to begin to learn how to get paid for care differently," she said.

Dr. Cecil B. Wilson, AMA immediate past president, said the organization will urge federal officials to encourage applications for physician-led bundling projects.

"For this to be successful, and for physicians to participate actively, then they need to be a part of that process rather than just some larger corporation or larger hospital system or health plan that’s organizing these," he said. "We think those are important as well, but we also think it’s important that physicians be a part of that leadership."

While there are physicians working in large group practices that have had some experience with bundled payments, most doctors aren’t prepared for these types of payment changes, Dr. Wilson said. So the AMA is also recommending that CMS provide technical assistance and data to interested physicians.

Health care consultant Robert Minkin urged physicians to apply for the bundling program. "The implications of bundled payments and other clinical integration models are that we come to a common, best-evidence practice approach to care that manages on a fixed budget," said Mr. Minkin, of the Camden Group. "Physicians who can survive in an environment like that will thrive. For those who have difficulty in those situations, it’s going to be very tough."

Physicians and hospitals now have the chance to test out bundled payments on a range of conditions under a new Medicare initiative.

Officials at the Centers for Medicare and Medicaid Services have invited physicians, hospitals, and other health care providers to participate in the Bundled Payments for Care Improvement initiative. The program, which was mandated under the Affordable Care Act, offers a variety of options for bundling payments for a hospital stay, for post-discharge services, or for both the hospital stay and the post-discharge care.

The move toward bundled payments is a major shift in how the government pays for medical care. Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care for a specific condition. The aim of the program is to incentivize clinicians to work together and provide better continuity of care, resulting in better quality and lower costs.

"Today, Medicare pays for care the wrong way," Health and Human Services Secretary Kathleen Sebelius said during a teleconference to announce the bundling program. "Payments are based on the quantity of care, the amount of services delivered, not the quality of that care. And that leaves us too often with a system that actually can punish the providers that are most successful at getting and keeping their patients healthy."

The new bundling program offers four ways that health care providers can receive a bundled payment, three of which provide payment retrospectively, and one that offers a prospective payment. For example, under some of the retrospective payment models, CMS and the providers would agree on a target payment amount for the episode of care and providers would be paid under the original Medicare fee-for-service system, but at a negotiated discount of 2% to 3% or greater. At the end of the care episode, the total payment would be compared with the target price and providers would be able to share in the savings, according to CMS.

The prospective payment model would work differently. Under that option, CMS would make a single bundled payment to the hospital to cover all services provided during the inpatient stay by the hospital, physicians, and other providers. That payment would offer at least a 3% discount to Medicare. Under this option, physicians and other providers would submit "no pay" claims to Medicare and the hospital would pay them out of the single bundled payment.

In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care will be and what conditions they want to bundle payment for, and what services would be included in the payment. CMS officials said they wanted to make the program flexible so that a range of hospitals, physicians, and other providers could participate.

Organizations interested in applying must submit a letter of intent by Sept. 22 for Model 1 and by Nov. 4 for Models 2, 3, and 4. More information on the program and how to apply is seen at www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html.

Dr. Richard Gilfillan, the acting director of the CMS Innovation Center, which is overseeing the bundling initiative, said he expects that hundreds of organizations will apply. CMS will consider a number of factors in choosing participants for the program including the best proposals for care improvement, the number of patients involved, and the conditions addressed, and the price discounts offered, he said.

The program is a unique opportunity for hospitals to redesign their systems to promote better care coordination, Dr. Gilfillan said, and have that effort supported through Medicare payments.

The idea is to eliminate the traditional barriers between physicians and other providers – both inpatient and outpatient – all of whom may be involved in the care of a single condition, said Dr. Nancy Nielson, senior advisor to the CMS Innovation Center and past president of the American Medical Association. "I do believe that both physicians and hospitals will find this [to be] an opportunity that’s flexible enough to give them the opportunity to begin to learn how to get paid for care differently," she said.

Dr. Cecil B. Wilson, AMA immediate past president, said the organization will urge federal officials to encourage applications for physician-led bundling projects.

"For this to be successful, and for physicians to participate actively, then they need to be a part of that process rather than just some larger corporation or larger hospital system or health plan that’s organizing these," he said. "We think those are important as well, but we also think it’s important that physicians be a part of that leadership."

While there are physicians working in large group practices that have had some experience with bundled payments, most doctors aren’t prepared for these types of payment changes, Dr. Wilson said. So the AMA is also recommending that CMS provide technical assistance and data to interested physicians.

Health care consultant Robert Minkin urged physicians to apply for the bundling program. "The implications of bundled payments and other clinical integration models are that we come to a common, best-evidence practice approach to care that manages on a fixed budget," said Mr. Minkin, of the Camden Group. "Physicians who can survive in an environment like that will thrive. For those who have difficulty in those situations, it’s going to be very tough."

Physicians and hospitals now have the chance to test out bundled payments on a range of conditions under a new Medicare initiative.

Officials at the Centers for Medicare and Medicaid Services have invited physicians, hospitals, and other health care providers to participate in the Bundled Payments for Care Improvement initiative. The program, which was mandated under the Affordable Care Act, offers a variety of options for bundling payments for a hospital stay, for post-discharge services, or for both the hospital stay and the post-discharge care.

The move toward bundled payments is a major shift in how the government pays for medical care. Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care for a specific condition. The aim of the program is to incentivize clinicians to work together and provide better continuity of care, resulting in better quality and lower costs.

"Today, Medicare pays for care the wrong way," Health and Human Services Secretary Kathleen Sebelius said during a teleconference to announce the bundling program. "Payments are based on the quantity of care, the amount of services delivered, not the quality of that care. And that leaves us too often with a system that actually can punish the providers that are most successful at getting and keeping their patients healthy."

The new bundling program offers four ways that health care providers can receive a bundled payment, three of which provide payment retrospectively, and one that offers a prospective payment. For example, under some of the retrospective payment models, CMS and the providers would agree on a target payment amount for the episode of care and providers would be paid under the original Medicare fee-for-service system, but at a negotiated discount of 2% to 3% or greater. At the end of the care episode, the total payment would be compared with the target price and providers would be able to share in the savings, according to CMS.

The prospective payment model would work differently. Under that option, CMS would make a single bundled payment to the hospital to cover all services provided during the inpatient stay by the hospital, physicians, and other providers. That payment would offer at least a 3% discount to Medicare. Under this option, physicians and other providers would submit "no pay" claims to Medicare and the hospital would pay them out of the single bundled payment.

In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care will be and what conditions they want to bundle payment for, and what services would be included in the payment. CMS officials said they wanted to make the program flexible so that a range of hospitals, physicians, and other providers could participate.

Organizations interested in applying must submit a letter of intent by Sept. 22 for Model 1 and by Nov. 4 for Models 2, 3, and 4. More information on the program and how to apply is seen at www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html.

Dr. Richard Gilfillan, the acting director of the CMS Innovation Center, which is overseeing the bundling initiative, said he expects that hundreds of organizations will apply. CMS will consider a number of factors in choosing participants for the program including the best proposals for care improvement, the number of patients involved, and the conditions addressed, and the price discounts offered, he said.

The program is a unique opportunity for hospitals to redesign their systems to promote better care coordination, Dr. Gilfillan said, and have that effort supported through Medicare payments.

The idea is to eliminate the traditional barriers between physicians and other providers – both inpatient and outpatient – all of whom may be involved in the care of a single condition, said Dr. Nancy Nielson, senior advisor to the CMS Innovation Center and past president of the American Medical Association. "I do believe that both physicians and hospitals will find this [to be] an opportunity that’s flexible enough to give them the opportunity to begin to learn how to get paid for care differently," she said.

Dr. Cecil B. Wilson, AMA immediate past president, said the organization will urge federal officials to encourage applications for physician-led bundling projects.

"For this to be successful, and for physicians to participate actively, then they need to be a part of that process rather than just some larger corporation or larger hospital system or health plan that’s organizing these," he said. "We think those are important as well, but we also think it’s important that physicians be a part of that leadership."

While there are physicians working in large group practices that have had some experience with bundled payments, most doctors aren’t prepared for these types of payment changes, Dr. Wilson said. So the AMA is also recommending that CMS provide technical assistance and data to interested physicians.

Health care consultant Robert Minkin urged physicians to apply for the bundling program. "The implications of bundled payments and other clinical integration models are that we come to a common, best-evidence practice approach to care that manages on a fixed budget," said Mr. Minkin, of the Camden Group. "Physicians who can survive in an environment like that will thrive. For those who have difficulty in those situations, it’s going to be very tough."

Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.

Physicians employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report.

The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

"The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency," said Dr. Ann S. O’Malley of the Center for Studying Health System Change and a coauthor of the study.

The trend toward hospitals’ employing more physicians can also drive up costs because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician’s office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.

Hospital employment of physicians does have the potential to improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital.

The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.

Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.

Physicians employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report.

The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

"The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency," said Dr. Ann S. O’Malley of the Center for Studying Health System Change and a coauthor of the study.

The trend toward hospitals’ employing more physicians can also drive up costs because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician’s office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.

Hospital employment of physicians does have the potential to improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital.

The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.

Hospital employment of physicians continues to rise rapidly around the country, but the trend could drive up costs at least in the short term, according to a report from the Center for Studying Health System Change.

Physicians employed by hospitals are often paid based on their productivity, which offers an incentive to increase the volume of services. And in some cases, physicians are under pressure from their hospitals to order more expensive tests, according to the report.

The researchers from the Center for Studying Health System Change based their analysis on interviews with nearly 550 physicians, hospital executives, health plan officials, and others, in 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey, Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

"The acceleration in hospital employment of physicians risks raising costs and not improving quality of care unless payment reforms shift provider incentives away from volume toward higher quality and efficiency," said Dr. Ann S. O’Malley of the Center for Studying Health System Change and a coauthor of the study.

The trend toward hospitals’ employing more physicians can also drive up costs because hospitals are able to charge hospital facility fees for office visits and procedures, even when those services are administered in a physician’s office. That means that Medicare – and in some cases private insurers – are paying significantly more for the same services simply because the physician is employed by the hospital.

Hospital employment of physicians does have the potential to improve quality through better integration of care and communication between physicians. The problem, the researchers noted, is that integration and communication can be slow to improve just because physicians get their paychecks from the hospital.

The research was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.

Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.

The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula used to set Medicare payments to physicians.

Physicians’ groups, led by the American Medical Association, lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.

The new law of the land, the Budget Control Act of 2011, puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.

The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel iswill be comprised of legislators from both parties and both houses of Congress.

Sen. Patty Murray (D.-Wash Rep. Dave Camp (R.-Mich.), chairman of the House Ways and Means Committee, Rep. Fred Upton (R.-Mich.), chairman of the House Energy and Commerce Committee, Rep. James E. Clyburn (D.-S.C.), the third-ranking member of the House Democratic leadership, Rep. Xavier Becerra (D.-Calif.), a member of the House Ways and Means Committee, and Rep. Chris Van Hollen (D.-Md.), also a member of the House Ways and Means Committee. The appointments were made by party leaders in the House and Senate.

Party leaders have named the first nine members of the joint committee. Senate Majority Leader Harry Reid (D.-Nev.) appointed«http://democrats.senate.gov/2011/08/09/reid-announces-appointments-to-joint-select-committee-on-deficit-reduction/» Sen. Patty Murray (D.-Wash.)« http://murray.senate.gov/public/», who serves on both the Senate budget and appropriations committees, to co-chair the Joint Select Committee on Deficit Reduction. Her appointment immediately drew criticism from Republicans, who said she is too focused on politics because of her role as chairwoman of the Democratic Senatorial Campaign Committee. Sen. Reid also tapped Sen. Max Baucus (D.-Mont.)« http://baucus.senate.gov/», chairman of the Senate Finance Committee and an architect of the Affordable Care Act, and Sen. John Kerry (D.-Mass.)« http://kerry.senate.gov/», who was the 2004 Democratic presidential nominee, to serve on the joint committee.

Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.

"There’s a lot of concern that the committee will be deadlocked," said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.

The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee’s bill by Dec. 23.

To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee’s bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.

Should the joint committee’s bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.

Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year.

The hope for physicians is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect. Many physicians think that Congress will do something to avert the massive SGR cut, even if it’s a temporary fix.

For example, Dr. Jonathan Leffert, chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists, said: "Medicare patients not being able to see their physicians is pretty toxic for both Democrats and Republicans."

Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.

The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula used to set Medicare payments to physicians.

Physicians’ groups, led by the American Medical Association, lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.

The new law of the land, the Budget Control Act of 2011, puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.

The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel iswill be comprised of legislators from both parties and both houses of Congress.

Sen. Patty Murray (D.-Wash Rep. Dave Camp (R.-Mich.), chairman of the House Ways and Means Committee, Rep. Fred Upton (R.-Mich.), chairman of the House Energy and Commerce Committee, Rep. James E. Clyburn (D.-S.C.), the third-ranking member of the House Democratic leadership, Rep. Xavier Becerra (D.-Calif.), a member of the House Ways and Means Committee, and Rep. Chris Van Hollen (D.-Md.), also a member of the House Ways and Means Committee. The appointments were made by party leaders in the House and Senate.

Party leaders have named the first nine members of the joint committee. Senate Majority Leader Harry Reid (D.-Nev.) appointed«http://democrats.senate.gov/2011/08/09/reid-announces-appointments-to-joint-select-committee-on-deficit-reduction/» Sen. Patty Murray (D.-Wash.)« http://murray.senate.gov/public/», who serves on both the Senate budget and appropriations committees, to co-chair the Joint Select Committee on Deficit Reduction. Her appointment immediately drew criticism from Republicans, who said she is too focused on politics because of her role as chairwoman of the Democratic Senatorial Campaign Committee. Sen. Reid also tapped Sen. Max Baucus (D.-Mont.)« http://baucus.senate.gov/», chairman of the Senate Finance Committee and an architect of the Affordable Care Act, and Sen. John Kerry (D.-Mass.)« http://kerry.senate.gov/», who was the 2004 Democratic presidential nominee, to serve on the joint committee.

Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.

"There’s a lot of concern that the committee will be deadlocked," said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.

The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee’s bill by Dec. 23.

To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee’s bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.

Should the joint committee’s bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.

Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year.

The hope for physicians is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect. Many physicians think that Congress will do something to avert the massive SGR cut, even if it’s a temporary fix.

For example, Dr. Jonathan Leffert, chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists, said: "Medicare patients not being able to see their physicians is pretty toxic for both Democrats and Republicans."

Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.

The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula used to set Medicare payments to physicians.

Physicians’ groups, led by the American Medical Association, lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.

The new law of the land, the Budget Control Act of 2011, puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.

The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel iswill be comprised of legislators from both parties and both houses of Congress.

Sen. Patty Murray (D.-Wash Rep. Dave Camp (R.-Mich.), chairman of the House Ways and Means Committee, Rep. Fred Upton (R.-Mich.), chairman of the House Energy and Commerce Committee, Rep. James E. Clyburn (D.-S.C.), the third-ranking member of the House Democratic leadership, Rep. Xavier Becerra (D.-Calif.), a member of the House Ways and Means Committee, and Rep. Chris Van Hollen (D.-Md.), also a member of the House Ways and Means Committee. The appointments were made by party leaders in the House and Senate.

Party leaders have named the first nine members of the joint committee. Senate Majority Leader Harry Reid (D.-Nev.) appointed«http://democrats.senate.gov/2011/08/09/reid-announces-appointments-to-joint-select-committee-on-deficit-reduction/» Sen. Patty Murray (D.-Wash.)« http://murray.senate.gov/public/», who serves on both the Senate budget and appropriations committees, to co-chair the Joint Select Committee on Deficit Reduction. Her appointment immediately drew criticism from Republicans, who said she is too focused on politics because of her role as chairwoman of the Democratic Senatorial Campaign Committee. Sen. Reid also tapped Sen. Max Baucus (D.-Mont.)« http://baucus.senate.gov/», chairman of the Senate Finance Committee and an architect of the Affordable Care Act, and Sen. John Kerry (D.-Mass.)« http://kerry.senate.gov/», who was the 2004 Democratic presidential nominee, to serve on the joint committee.

Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.

"There’s a lot of concern that the committee will be deadlocked," said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.

The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee’s bill by Dec. 23.

To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee’s bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.

Should the joint committee’s bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.

Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year.

The hope for physicians is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect. Many physicians think that Congress will do something to avert the massive SGR cut, even if it’s a temporary fix.

For example, Dr. Jonathan Leffert, chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists, said: "Medicare patients not being able to see their physicians is pretty toxic for both Democrats and Republicans."