Snow (not Snowe) Postpones the Jobs Bill

Though Senate Majority Leader Harry Reid (D-NV) had hoped to finalize a comprehensive jobs package by the end of the week, the District was hit by a second major snow storm in less than a week which abruptly halted any discussions.  For the first time in over a year snow – not Snowe (i.e. Senator Olympia Snowe – R-ME) – was the dominant force in Washington that dictated the agenda of Congress. As Washington begins to shovel out of the massive storm, the politics swirling about jobs are immense.  It’s equally clear that there are many elements of the $80 some billion bill that could benefit the healthcare community – if it gains traction and passes.

The first and most important aspect of the jobs bill from a healthcare perspective would be a policy shift that allows hospital-based physicians to access government subsidies to support the purchase of electronic health record systems. Though the comprehensive package is still in flux and will be debated by the Senate, the proposal would amend last year’s stimulus bill –the American Recovery and Reinvestment Act (ARRA) – which restricted hospital-based doctors from accessing Medicare or Medicare subsidies for health technology.   Since many hospital-based doctors use an EHR that is different from their hospital system, it seems to many of us that the ARRA stimulus approach created an inequity.  With the proposed changes included in the new jobs package, it now appears that the problem could be rectified although there’s still a ways to go before Congress makes a final decision.

In addition to the substantial changes targeted at the hospital-based physicians, the jobs package also includes some substantial modifications in a number of areas, including: 

• Doc Fix Extension – In December, Congress passed a freeze on Medicare physician payments at 2009 levels through February 28th to avoid a 21% projected cut that was set to begin at the first of the year.  The jobs bill extends the freeze for an additional seven months until September 30^th.
• No Change for Medicare Advantage– The bill instructs CMS to assume no doc fix update for the 2010 and 2011 Medicare Advantage payment rates.  According to a CMS report in 2009, assuming a doc fix for the program in 2010 will add 3 – 4% to the rates in 2011.
• COBRA Subsidy Extension– In December, Congress passed a two-month extension of federal subsidies to purchase COBRA health benefits for those who are unemployed.  The bill extends the subsidies for an additional three months through May 31^st.
• Ambulance Transportation Funding– The bill includes a one year extension of provisions from 2008 which established an additional 3% increase for ground ambulance transportation in rural communities and, a 2% increase in other areas. 
• Long Term Care Hospitals– The bill includes a one year extension of the MMSEA (Medicare, Medicaid, and SCHIP Extension ACT) provisions to December 2010.  Those provisions created a moratorium on referral source limitations regarding hospitals-within-hospitals and satellite facilities as well as a moratorium on new long term care hospitals and hospital bed increases.

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.