U.S. senators who oppose the changes fell two votes short, 58-40, late Thursday in an attempt to bring to a vote legislation that would have halted or delayed the changes -- a 10 percent cut in federal reimbursements to doctors who treat Medicare patients, and a competitive bidding process for providers of equipment such as wheelchairs and oxygen.
"For physicians on the front line, who need Medicare payments to support their practices, further cuts or reimbursements that do not keep up with inflation may drive more physicians out of practice, or force them to limit the types of patients they see," said Dr. Adam Gordon, president of the Allegheny County Medical Society.
Cindy Wilson, general manager of UPMC Home Medical Equipment, was just as critical of the bidding procedure that begins in Pittsburgh and nine other cities next week. Locally, it affects about 300,000 traditional Medicare recipients.
"These beneficiaries were only notified last Saturday" by Medicare administrators, she said. And while the changes apply only to traditional recipients, who get their benefits directly from the federal government, members of managed Medicare plans such as UPMC for Life got the letters, creating more confusion.
"These people are disabled. They're on home oxygen, in hospital beds and in very complex wheelchairs -- and they're supposed to figure all this out in seven days?" she said.
The Senate could revisit the measure again after the July 4 recess. Wilson said the Centers for Medicare and Medicaid Services could opt to delay the changes.
Medicare officials have said that the bidding will reduce prices by an average 26 percent and project that when fully implemented, the system could save $1 billion annually. Medicare spent $8.6 billion on durable medical equipment in fiscal 2007, which ended in September.
The House had voted 355 to 59 this week to push back the bidding program by 18 months. Rep. Jason Altmire, D-McCandless, who pushed for the delay, had hoped the momentum would carry to the Senate. The Senate's inaction, he said yesterday, "could spell disaster for seniors, physicians and small home medical suppliers," he said.
Democratic Sen. Bob Casey Jr. of Scranton voted for taking action on the delay.
But Sen. Arlen Specter of Philadelphia, a Republican, opposed bringing the delay measure to a vote, saying he was given the bill Thursday night "with the ultimatum to either take it or leave it with no opportunity to offer any amendments" because House members had left town.
A 30-day extension on the physicians' cuts had been expected, but didn't happen because of political maneuvering, Specter said, adding he expects the cuts to be eliminated and other changes made in early July.
Medicare's new bidding process awarded contracts to companies that will supply recipients with 10 categories of medical supplies. Large national companies often won out over smaller, independent providers because their bids were lower, UPMC's Wilson said, but many devices such as wheelchairs are specially fitted for those using them, and require education and maintenance services.
Until now, patients have been able to buy equipment through Medicare from companies in their communities. But 38 percent of the contract-winning companies in the Pittsburgh region are from out of state, Wilson said, adding that UPMC submitted bids, but lost out to companies that quoted lower prices.
After Tuesday, patients using Medicare's system to order oxygen, for example, might have to call Tampa, Fla., or Indiana, she said. And because companies won or lost in various bid categories, they might have to call different providers to get a hospital bed or feeding equipment rather than ordering everything from one company.
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