WASHINGTON—Congress overwhelmingly overrode President Bush’s veto of Medicare legislation yesterday making the bill law that will halt the 10.6 percent physician fee cut as well as reform the End-Stage Renal Disease Program with an annual update, kidney disease education and prevention programs and a bundled payment system.
The focus of the Medicare Improvements for Patients and Providers Act of 2008 was to stop the 10.6 Medicare physician fee cut, which went into effect July 1. Its implementation, however, was delayed to give Congress time to act.
The House voted 383 to 41 to override the veto. That number included 153 Republicans. In the Senate, the final tally was 70 to 26, 21 Republicans voted to override Bush’s veto.
H.R. 6331 received more support with the override than when it was approved. Last month, the House voted 355 to 59 to pass the bill and the Senate voted 69 to 30.
This is the third time Congress has overridden a veto by Bush. "I support the primary objective of this legislation, to forestall reductions in physician payments," Bush said July 15 in a message to Congress. "Yet taking choices away from seniors to pay physicians is wrong."
The main point of contention for Bush and many Republicans was the bill's cut to private Medicare Advantage plans, which give seniors the ability to choose a private plan subsidized by Medicare instead of traditional Medicare.
Kidney Disease Provisions
The End-Stage Renal Disease program, which has long been without an inflationary reimbursement update, will also see a number of changes. With the new law, providers will see a 1 percent increase in the composite rate reimbursement in 2009 and 2010. The rate includes all the services needed to provide a dialysis treatment, including routine drugs, lab tests, supplies and equipment.
In addition, a fully bundled payment system will be established by Jan. 1, 2011. The new payment system will include an annual reimbursement update. The bundled payment will include the services covered under the composite rate as well as drugs, biologics and lab tests that are currently billed separately. Case-mix adjustors and add-ons will be added to reimbursement for low-volume providers. The new payment system will also allow adjustments based on geographic location.
Medicare will also establish a quality incentive payment program by Jan. 1, 2011. It will require ESRD providers to “meet quality metrics endorsed by a consensus-based, standard-setting body by demonstrating improvement or high levels of achievement,” according to language in the bill.
The new law also requires Medicare to create kidney disease awareness, screening and surveillance projects to help decrease and prevent kidney disease. In addition, the new law requires coverage of kidney disease education services to help beneficiaries manage comorbidities, prevent additional complications, and understand all treatment options, including home dialysis.
“The kidney community applauds the U.S. Congress for recognizing the imperative need for kidney disease provisions for million of Americans who suffer from kidney failure," Edward Jones, MD, chairman of the advocacy group Kidney Care Partners. “We look forward to working with Congress and the Administration in the coming months in the battle against kidney disease.”
