Alicia Ault

WASHINGTON - Spending for physician services grew half a percentage point more in 2012 than 2011, according to an annual analysis of health care spending from the National Health Expenditure Accounts Team at the Centers for Medicare and Medicaid Services.

The uptick in spending growth was partially attributable to more physician visits as American pocketbooks began to rebound from the recent recession, Anne B. Martin and her colleagues at the CMS Office of the Actuary said at a briefing Jan. 6.

The impact of the Affordable Care Act on spending growth remained negligible in 2012, as it was in the two prior years, according to their analysis, published simultaneously in the journal Health Affairs (2014;33:67-77 [doi 10/1377/hlthaff.2013.1254]).

The CMS actuaries estimated that, overall, the law increased spending by 0.1% from 2010 to 2012. A few ACA provisions – such as coverage for dependents under age 26 and for patients with pre-existing conditions – increased spending, while others – such as payment cuts to hospitals and rebates for drugs under Medicaid – decreased spending.

Courtesy Health Affairs

Overall, the nation’s health spending – $2.8 *trillion in 2012, the most recent year for which there are accurate and complete data – grew 3.7% in 2012, a historically low rate similar to that seen in the previous 3 years. The flat spending reflects trends seen over the years, in particular with the last three boom-and-bust cycles of the economy, said the CMS actuaries. That is, when the economy does well, health spending rises. When there is a recession, health spending decreases; the rebound in spending often lags an economic recovery by several years, said Aaron Catlin, deputy director of the National Health Statistics Group in the Office of the Actuary.

Certain categories of spending did see growth increases or decreases in 2012 that were the result of one-time events, they said.

Spending on physician services by all payers grew by 4% to $452 billion in 2012. While still not approaching the 5.3% increase in 2008, it’s a rebound from just over 3% growth in 2009 and 2010. Physician services grew 3.5% in 2011 and the upward trend continued in 2012 "primarily because of an increase in visits to doctors’ offices as the economy continued to recover from the recent severe economic recession," Ms. Martin said.

Consumers are shouldering a growing share of their health costs, especially for physician services. Out-of-pocket spending on deductibles and copays grew by 3.8% in 2012. The amount Americans spent on health care, including premiums for private insurance and Medicare, and copays, deductibles, and other uncovered costs, grew 4.3% in 2012, compared to 3.1% in 2011.

Medicare, on the other hand, clamped down on physician pay rates and the volume of care it paid for, even as enrollment grew 4.1% in 2012 – the largest 1-year increase in enrollment in 39 years.

That enrollment growth helped drive an uptick in overall spending on hospital services, which is the largest category of national health expenditures, eating up 32% of the total pie. Hospital spending increased 4.9% in 2012 to $882 billion.

Medicaid spending in 2012 continued a pattern of historically low growth, in part because of slower enrollment as the economy rebounded and also as states continued efforts to rein in the program’s costs. Overall, the Medicaid tab was $421 billion in 2012.

Finally, growth in prescription drug spending slowed precipitously for all Americans – from 2.5% in 2011 to 0.4% in 2012 – even as the number of dispensed prescriptions grew by 1.4%, compared to only a 0.5% increase in 2011. The actuaries noted that this slowing was due in large part to the expanded use of generic drugs. Three top sellers went off patent in late 2011 and 2012: atorvastatin (Lipitor), clopidogrel (Plavix), and montelukast (Singulair). Generic drugs accounted for 77% of all dispensed prescriptions in 2012.

The authors disclosed no relevant conflicts of interest and noted that opinions expressed are their own and not necessarily those of the CMS.

[email protected]

On Twitter @aliciaault

*CORRECTION 1/13/14: A previous version of this article incorrectly reported the cost of the nation's overall health spending. This article has been updated.

WASHINGTON - Spending for physician services grew half a percentage point more in 2012 than 2011, according to an annual analysis of health care spending from the National Health Expenditure Accounts Team at the Centers for Medicare and Medicaid Services.

The uptick in spending growth was partially attributable to more physician visits as American pocketbooks began to rebound from the recent recession, Anne B. Martin and her colleagues at the CMS Office of the Actuary said at a briefing Jan. 6.

The impact of the Affordable Care Act on spending growth remained negligible in 2012, as it was in the two prior years, according to their analysis, published simultaneously in the journal Health Affairs (2014;33:67-77 [doi 10/1377/hlthaff.2013.1254]).

The CMS actuaries estimated that, overall, the law increased spending by 0.1% from 2010 to 2012. A few ACA provisions – such as coverage for dependents under age 26 and for patients with pre-existing conditions – increased spending, while others – such as payment cuts to hospitals and rebates for drugs under Medicaid – decreased spending.

Courtesy Health Affairs

Overall, the nation’s health spending – $2.8 *trillion in 2012, the most recent year for which there are accurate and complete data – grew 3.7% in 2012, a historically low rate similar to that seen in the previous 3 years. The flat spending reflects trends seen over the years, in particular with the last three boom-and-bust cycles of the economy, said the CMS actuaries. That is, when the economy does well, health spending rises. When there is a recession, health spending decreases; the rebound in spending often lags an economic recovery by several years, said Aaron Catlin, deputy director of the National Health Statistics Group in the Office of the Actuary.

Certain categories of spending did see growth increases or decreases in 2012 that were the result of one-time events, they said.

Spending on physician services by all payers grew by 4% to $452 billion in 2012. While still not approaching the 5.3% increase in 2008, it’s a rebound from just over 3% growth in 2009 and 2010. Physician services grew 3.5% in 2011 and the upward trend continued in 2012 "primarily because of an increase in visits to doctors’ offices as the economy continued to recover from the recent severe economic recession," Ms. Martin said.

Consumers are shouldering a growing share of their health costs, especially for physician services. Out-of-pocket spending on deductibles and copays grew by 3.8% in 2012. The amount Americans spent on health care, including premiums for private insurance and Medicare, and copays, deductibles, and other uncovered costs, grew 4.3% in 2012, compared to 3.1% in 2011.

Medicare, on the other hand, clamped down on physician pay rates and the volume of care it paid for, even as enrollment grew 4.1% in 2012 – the largest 1-year increase in enrollment in 39 years.

That enrollment growth helped drive an uptick in overall spending on hospital services, which is the largest category of national health expenditures, eating up 32% of the total pie. Hospital spending increased 4.9% in 2012 to $882 billion.

Medicaid spending in 2012 continued a pattern of historically low growth, in part because of slower enrollment as the economy rebounded and also as states continued efforts to rein in the program’s costs. Overall, the Medicaid tab was $421 billion in 2012.

Finally, growth in prescription drug spending slowed precipitously for all Americans – from 2.5% in 2011 to 0.4% in 2012 – even as the number of dispensed prescriptions grew by 1.4%, compared to only a 0.5% increase in 2011. The actuaries noted that this slowing was due in large part to the expanded use of generic drugs. Three top sellers went off patent in late 2011 and 2012: atorvastatin (Lipitor), clopidogrel (Plavix), and montelukast (Singulair). Generic drugs accounted for 77% of all dispensed prescriptions in 2012.

The authors disclosed no relevant conflicts of interest and noted that opinions expressed are their own and not necessarily those of the CMS.

[email protected]

On Twitter @aliciaault

*CORRECTION 1/13/14: A previous version of this article incorrectly reported the cost of the nation's overall health spending. This article has been updated.

WASHINGTON - Spending for physician services grew half a percentage point more in 2012 than 2011, according to an annual analysis of health care spending from the National Health Expenditure Accounts Team at the Centers for Medicare and Medicaid Services.

The uptick in spending growth was partially attributable to more physician visits as American pocketbooks began to rebound from the recent recession, Anne B. Martin and her colleagues at the CMS Office of the Actuary said at a briefing Jan. 6.

The impact of the Affordable Care Act on spending growth remained negligible in 2012, as it was in the two prior years, according to their analysis, published simultaneously in the journal Health Affairs (2014;33:67-77 [doi 10/1377/hlthaff.2013.1254]).

The CMS actuaries estimated that, overall, the law increased spending by 0.1% from 2010 to 2012. A few ACA provisions – such as coverage for dependents under age 26 and for patients with pre-existing conditions – increased spending, while others – such as payment cuts to hospitals and rebates for drugs under Medicaid – decreased spending.

Courtesy Health Affairs

Overall, the nation’s health spending – $2.8 *trillion in 2012, the most recent year for which there are accurate and complete data – grew 3.7% in 2012, a historically low rate similar to that seen in the previous 3 years. The flat spending reflects trends seen over the years, in particular with the last three boom-and-bust cycles of the economy, said the CMS actuaries. That is, when the economy does well, health spending rises. When there is a recession, health spending decreases; the rebound in spending often lags an economic recovery by several years, said Aaron Catlin, deputy director of the National Health Statistics Group in the Office of the Actuary.

Certain categories of spending did see growth increases or decreases in 2012 that were the result of one-time events, they said.

Spending on physician services by all payers grew by 4% to $452 billion in 2012. While still not approaching the 5.3% increase in 2008, it’s a rebound from just over 3% growth in 2009 and 2010. Physician services grew 3.5% in 2011 and the upward trend continued in 2012 "primarily because of an increase in visits to doctors’ offices as the economy continued to recover from the recent severe economic recession," Ms. Martin said.

Consumers are shouldering a growing share of their health costs, especially for physician services. Out-of-pocket spending on deductibles and copays grew by 3.8% in 2012. The amount Americans spent on health care, including premiums for private insurance and Medicare, and copays, deductibles, and other uncovered costs, grew 4.3% in 2012, compared to 3.1% in 2011.

Medicare, on the other hand, clamped down on physician pay rates and the volume of care it paid for, even as enrollment grew 4.1% in 2012 – the largest 1-year increase in enrollment in 39 years.

That enrollment growth helped drive an uptick in overall spending on hospital services, which is the largest category of national health expenditures, eating up 32% of the total pie. Hospital spending increased 4.9% in 2012 to $882 billion.

Medicaid spending in 2012 continued a pattern of historically low growth, in part because of slower enrollment as the economy rebounded and also as states continued efforts to rein in the program’s costs. Overall, the Medicaid tab was $421 billion in 2012.

Finally, growth in prescription drug spending slowed precipitously for all Americans – from 2.5% in 2011 to 0.4% in 2012 – even as the number of dispensed prescriptions grew by 1.4%, compared to only a 0.5% increase in 2011. The actuaries noted that this slowing was due in large part to the expanded use of generic drugs. Three top sellers went off patent in late 2011 and 2012: atorvastatin (Lipitor), clopidogrel (Plavix), and montelukast (Singulair). Generic drugs accounted for 77% of all dispensed prescriptions in 2012.

The authors disclosed no relevant conflicts of interest and noted that opinions expressed are their own and not necessarily those of the CMS.

[email protected]

On Twitter @aliciaault

*CORRECTION 1/13/14: A previous version of this article incorrectly reported the cost of the nation's overall health spending. This article has been updated.

Physicians will get a 0.5% raise in Medicare pay on Jan. 1, thanks to a last-minute legislative fix to the Sustainable Growth Rate formula signed into law by President Obama on Dec. 26.

The Pathway for SGR Reform Act of 2013 was attached as an amendment to the Bipartisan Budget Agreement of 2013. The budget deal, brokered by Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wisc.), passed the House on Dec. 12 and the Senate on Dec. 18. The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The law also extends the 2% sequestration cut to Medicare payments by 2 years, to 2023.

It encourages the Centers for Medicare and Medicaid Services to simplify physicians’ administrative burden by trying to more closely coordinate quality measure requirements and give doctors more timely feedback on those measures.

The law extends funding for a variety of other health-related federal programs for an additional 3 months, including for Area Agencies on Aging.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns on Jan. 6.

[email protected]

On Twitter @aliciaault

*Correction 2/05/14: The following passage was deleted from a previous version of this story as the provision was not included in the law as signed.

Finally, the law delays enforcement of the "two-midnight rule" until Oct. 2014. The goal of the two-midnight policy, which was included in the fiscal 2014 Inpatient Prospective Payment System final rule, is to cut down on hospitals using observation status to keep from admitting patients. Hospitals now have until Oct. 1, 2014 to adjust to the new policy, which requires patients to be admitted if physicians think they will need a stay longer than 48 hours.

Physicians will get a 0.5% raise in Medicare pay on Jan. 1, thanks to a last-minute legislative fix to the Sustainable Growth Rate formula signed into law by President Obama on Dec. 26.

The Pathway for SGR Reform Act of 2013 was attached as an amendment to the Bipartisan Budget Agreement of 2013. The budget deal, brokered by Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wisc.), passed the House on Dec. 12 and the Senate on Dec. 18. The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The law also extends the 2% sequestration cut to Medicare payments by 2 years, to 2023.

It encourages the Centers for Medicare and Medicaid Services to simplify physicians’ administrative burden by trying to more closely coordinate quality measure requirements and give doctors more timely feedback on those measures.

The law extends funding for a variety of other health-related federal programs for an additional 3 months, including for Area Agencies on Aging.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns on Jan. 6.

[email protected]

On Twitter @aliciaault

*Correction 2/05/14: The following passage was deleted from a previous version of this story as the provision was not included in the law as signed.

Finally, the law delays enforcement of the "two-midnight rule" until Oct. 2014. The goal of the two-midnight policy, which was included in the fiscal 2014 Inpatient Prospective Payment System final rule, is to cut down on hospitals using observation status to keep from admitting patients. Hospitals now have until Oct. 1, 2014 to adjust to the new policy, which requires patients to be admitted if physicians think they will need a stay longer than 48 hours.

Physicians will get a 0.5% raise in Medicare pay on Jan. 1, thanks to a last-minute legislative fix to the Sustainable Growth Rate formula signed into law by President Obama on Dec. 26.

The Pathway for SGR Reform Act of 2013 was attached as an amendment to the Bipartisan Budget Agreement of 2013. The budget deal, brokered by Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wisc.), passed the House on Dec. 12 and the Senate on Dec. 18. The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The law also extends the 2% sequestration cut to Medicare payments by 2 years, to 2023.

It encourages the Centers for Medicare and Medicaid Services to simplify physicians’ administrative burden by trying to more closely coordinate quality measure requirements and give doctors more timely feedback on those measures.

The law extends funding for a variety of other health-related federal programs for an additional 3 months, including for Area Agencies on Aging.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns on Jan. 6.

[email protected]

On Twitter @aliciaault

*Correction 2/05/14: The following passage was deleted from a previous version of this story as the provision was not included in the law as signed.

Finally, the law delays enforcement of the "two-midnight rule" until Oct. 2014. The goal of the two-midnight policy, which was included in the fiscal 2014 Inpatient Prospective Payment System final rule, is to cut down on hospitals using observation status to keep from admitting patients. Hospitals now have until Oct. 1, 2014 to adjust to the new policy, which requires patients to be admitted if physicians think they will need a stay longer than 48 hours.

The Senate has passed a budget package that includes a 3-month delay in physician pay cuts mandated by the Medicare Sustainable Growth Rate formula but also extends other overall Medicare budget cuts for 2 years.

The Senate voted 64-36 on Dec. 18 to approve the Bipartisan Budget Act of 2013 crafted by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wisc.). Nine Republican senators voted in favor of the deal, joining 55 Democrats.

The 3-month reprieve from the SGR cuts was added to the budget deal by the House before it voted to approve the package on Dec. 12.

Now, if President Obama signs the budget bill, which is expected, physicians will see 0.5% a month pay increase through Mar. 31.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The bill also would extend the 2% sequestration cut to Medicare payments by 2 years, to 2023.

The House has recessed and is not due back until Jan. 7. The Senate has not set its adjournment date yet, but is expected to reconvene on Jan. 6.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns.

[email protected]

On Twitter @aliciaault

The Senate has passed a budget package that includes a 3-month delay in physician pay cuts mandated by the Medicare Sustainable Growth Rate formula but also extends other overall Medicare budget cuts for 2 years.

The Senate voted 64-36 on Dec. 18 to approve the Bipartisan Budget Act of 2013 crafted by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wisc.). Nine Republican senators voted in favor of the deal, joining 55 Democrats.

The 3-month reprieve from the SGR cuts was added to the budget deal by the House before it voted to approve the package on Dec. 12.

Now, if President Obama signs the budget bill, which is expected, physicians will see 0.5% a month pay increase through Mar. 31.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The bill also would extend the 2% sequestration cut to Medicare payments by 2 years, to 2023.

The House has recessed and is not due back until Jan. 7. The Senate has not set its adjournment date yet, but is expected to reconvene on Jan. 6.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns.

[email protected]

On Twitter @aliciaault

The Senate has passed a budget package that includes a 3-month delay in physician pay cuts mandated by the Medicare Sustainable Growth Rate formula but also extends other overall Medicare budget cuts for 2 years.

The Senate voted 64-36 on Dec. 18 to approve the Bipartisan Budget Act of 2013 crafted by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wisc.). Nine Republican senators voted in favor of the deal, joining 55 Democrats.

The 3-month reprieve from the SGR cuts was added to the budget deal by the House before it voted to approve the package on Dec. 12.

Now, if President Obama signs the budget bill, which is expected, physicians will see 0.5% a month pay increase through Mar. 31.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The bill also would extend the 2% sequestration cut to Medicare payments by 2 years, to 2023.

The House has recessed and is not due back until Jan. 7. The Senate has not set its adjournment date yet, but is expected to reconvene on Jan. 6.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns.

[email protected]

On Twitter @aliciaault

The Senate has passed a budget package that includes a 3-month delay in physician pay cuts mandated by the Medicare Sustainable Growth Rate formula but also extends other overall Medicare budget cuts for 2 years.

The Senate voted 64-36 on Dec. 18 to approve the Bipartisan Budget Act of 2013 crafted by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wisc.). Nine Republican senators voted in favor of the deal, joining 55 Democrats.

The 3-month reprieve from the SGR cuts was added to the budget deal by the House before it voted to approve the package on Dec. 12.

Now, if President Obama signs the budget bill, which is expected, physicians will see 0.5% a month pay increase through Mar. 31.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The bill also would extend the 2% sequestration cut to Medicare payments by 2 years, to 2023.

The House has recessed and is not due back until Jan. 7. The Senate has not set its adjournment date yet, but is expected to reconvene on Jan. 6.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns.

[email protected]

On Twitter @aliciaault

The Senate has passed a budget package that includes a 3-month delay in physician pay cuts mandated by the Medicare Sustainable Growth Rate formula but also extends other overall Medicare budget cuts for 2 years.

The Senate voted 64-36 on Dec. 18 to approve the Bipartisan Budget Act of 2013 crafted by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wisc.). Nine Republican senators voted in favor of the deal, joining 55 Democrats.

The 3-month reprieve from the SGR cuts was added to the budget deal by the House before it voted to approve the package on Dec. 12.

Now, if President Obama signs the budget bill, which is expected, physicians will see 0.5% a month pay increase through Mar. 31.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The bill also would extend the 2% sequestration cut to Medicare payments by 2 years, to 2023.

The House has recessed and is not due back until Jan. 7. The Senate has not set its adjournment date yet, but is expected to reconvene on Jan. 6.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns.

[email protected]

On Twitter @aliciaault

The Senate has passed a budget package that includes a 3-month delay in physician pay cuts mandated by the Medicare Sustainable Growth Rate formula but also extends other overall Medicare budget cuts for 2 years.

The Senate voted 64-36 on Dec. 18 to approve the Bipartisan Budget Act of 2013 crafted by Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wisc.). Nine Republican senators voted in favor of the deal, joining 55 Democrats.

The 3-month reprieve from the SGR cuts was added to the budget deal by the House before it voted to approve the package on Dec. 12.

Now, if President Obama signs the budget bill, which is expected, physicians will see 0.5% a month pay increase through Mar. 31.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. It would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

The bill also would extend the 2% sequestration cut to Medicare payments by 2 years, to 2023.

The House has recessed and is not due back until Jan. 7. The Senate has not set its adjournment date yet, but is expected to reconvene on Jan. 6.

Congress is expected to start consideration again of a permanent replacement for the SGR when it returns.

[email protected]

On Twitter @aliciaault

WASHINGTON - Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year's end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.

In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.

The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.

The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.

Although physician groups aren't thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.

Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.

Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.

"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.

Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.

The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.

"This may not be the final step, it's a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.

The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.

The Senate Finance Committee also did not include a way to pay for repeal in its proposal.

The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.

Sen. Orrin Hatch (R- Utah), the committee's top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.

"This bill will be offset, period, or it's not going to go through both houses," he said. "This bill will be paid for."

The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.

Physician groups praised the continued congressional action.

The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare's failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."

The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.

"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."

The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."

"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.

Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.

"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn't add one dime to our nation's debt."

[email protected]

[email protected]

WASHINGTON - Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year's end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.

In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.

The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.

The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.

Although physician groups aren't thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.

Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.

Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.

"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.

Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.

The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.

"This may not be the final step, it's a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.

The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.

The Senate Finance Committee also did not include a way to pay for repeal in its proposal.

The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.

Sen. Orrin Hatch (R- Utah), the committee's top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.

"This bill will be offset, period, or it's not going to go through both houses," he said. "This bill will be paid for."

The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.

Physician groups praised the continued congressional action.

The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare's failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."

The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.

"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."

The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."

"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.

Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.

"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn't add one dime to our nation's debt."

[email protected]

[email protected]

WASHINGTON - Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year's end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.

In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.

The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.

The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.

Although physician groups aren't thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.

Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.

Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.

"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.

Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.

The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.

"This may not be the final step, it's a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.

The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.

The Senate Finance Committee also did not include a way to pay for repeal in its proposal.

The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.

Sen. Orrin Hatch (R- Utah), the committee's top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.

"This bill will be offset, period, or it's not going to go through both houses," he said. "This bill will be paid for."

The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.

Physician groups praised the continued congressional action.

The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare's failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."

The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.

"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."

The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."

"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.

Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.

"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn't add one dime to our nation's debt."

[email protected]

[email protected]

The Food and Drug Administration is proposing that manufacturers of antibacterial soaps prove by 2016 that the products are safe and effective, or they must be reformulated or relabeled.

The agency said it currently is looking only at consumer products. It will address antibacterial soaps used in the health care and food preparation settings separately. The proposal also does not affect alcohol-based hand sanitizers, which the agency has already recognized as generally safe and effective.

The Dec. 16 proposed rule is the result of a settlement with the Natural Resources Defense Council (NRDC). That nonprofit environmental group sued the agency in 2010 to force it to issue a final rule on a 1978 proposal to remove the antibacterial agent triclosan from certain consumer products.

The FDA now says that manufacturers will have to prove that antibacterial soaps and body washes – primarily made with triclosan and triclocarban – are safer and more effective than soap and water in preventing infection and the spread of germs. The agency estimates that at least 2,200 antibacterial soaps are on the market. Manufacturers have provided no evidence supporting their use, Dr. Sandra Kweder, deputy director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, said in a call with reporters. Those manufacturers will now be required to conduct studies to prove safety and effectiveness in humans.

There has been evidence in animal and in vitro studies that triclosan and triclocarban are endocrine disruptors, Dr. Kweder said.

With the antibacterial soaps, "there are unknowns and even a slight potential for a risk," she said. "We think consumers ought to know, and we ought to know, what the benefits of these products are."

The rule is open for comment until June 2014. The antibacterial soaps are allowed to remain on the market until the agency finalizes its proposal – not likely until September 2016, Dr. Kweder said. If manufacturers cannot demonstrate safety and effectiveness, the soaps will have to be reformulated without triclosan or relabeled to remove any antibacterial claims, Dr. Kweder said.

Manufacturers, however, said that they already have complied with agency requests for more data.

"We are perplexed that the Agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said the American Cleaning Institute and the Personal Care Products Council in a joint statement. "Our industry’s Topical Antimicrobial Coalition has submitted to FDA in-depth data showing that antibacterial soaps are more effective in killing germs when compared with non-antibacterial soaps," the statement said.

The groups said that they "will continue to operate in good faith to submit any new data that is available," but that manufacturers will submit comments to FDA "reaffirming that the use of antibacterial wash products in the home environment does not contribute to antibiotic or antibacterial resistance."

Consumer groups such as the NRDC, the Environmental Working Group, and others that have pressured the agency to more strictly regulate triclosan or remove it from the market applauded the FDA proposal, but noted that the examination of the ingredient has already been 30 years in the making.

Since the FDA first proposed regulating triclosan in 1978, it has revisited the topic multiple times, including at a 2005 advisory committee meeting. The panel said that the antibacterial soaps were ineffective and raised numerous safety concerns.

Mae Wu, an attorney with the NRDC’s health program, said in a statement that the agency’s proposal was "a good first step toward getting unsafe triclosan off the market."

Sen. Ed Markey (D-Mass.), who has urged the FDA to finalize its triclosan ruling and also has encouraged manufacturers to stop using it, said in a statement that "chemicals like triclosan existed in a regulatory black hole" for decades. "I applaud the FDA for taking a step to restrict the use of this harmful and ineffective chemical that continues to pollute our bodies," he said.

The FDA and the Environmental Protection Agency, among other agencies, have acknowledged triclosan’s potential to interfere with the normal functioning of estrogen, testosterone, and thyroid hormone. The National Toxicology Program continues to study the chemical, but the FDA wants manufacturers to come forward with information, too, Dr. Kweder said.

The FDA did approve the use of triclosan in Colgate Total toothpaste in 1997. The NRDC recently sued the FDA for access to its full records on that approval, saying that the ingredient should not be in toothpaste, either.

The FDA is not as concerned about the use in toothpaste, because it received data from the manufacturer showing that triclosan was safe and effective in that setting, Dr. Kweder said.

[email protected]

On Twitter @aliciaault

The Food and Drug Administration is proposing that manufacturers of antibacterial soaps prove by 2016 that the products are safe and effective, or they must be reformulated or relabeled.

The agency said it currently is looking only at consumer products. It will address antibacterial soaps used in the health care and food preparation settings separately. The proposal also does not affect alcohol-based hand sanitizers, which the agency has already recognized as generally safe and effective.

The Dec. 16 proposed rule is the result of a settlement with the Natural Resources Defense Council (NRDC). That nonprofit environmental group sued the agency in 2010 to force it to issue a final rule on a 1978 proposal to remove the antibacterial agent triclosan from certain consumer products.

The FDA now says that manufacturers will have to prove that antibacterial soaps and body washes – primarily made with triclosan and triclocarban – are safer and more effective than soap and water in preventing infection and the spread of germs. The agency estimates that at least 2,200 antibacterial soaps are on the market. Manufacturers have provided no evidence supporting their use, Dr. Sandra Kweder, deputy director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, said in a call with reporters. Those manufacturers will now be required to conduct studies to prove safety and effectiveness in humans.

There has been evidence in animal and in vitro studies that triclosan and triclocarban are endocrine disruptors, Dr. Kweder said.

With the antibacterial soaps, "there are unknowns and even a slight potential for a risk," she said. "We think consumers ought to know, and we ought to know, what the benefits of these products are."

The rule is open for comment until June 2014. The antibacterial soaps are allowed to remain on the market until the agency finalizes its proposal – not likely until September 2016, Dr. Kweder said. If manufacturers cannot demonstrate safety and effectiveness, the soaps will have to be reformulated without triclosan or relabeled to remove any antibacterial claims, Dr. Kweder said.

Manufacturers, however, said that they already have complied with agency requests for more data.

"We are perplexed that the Agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said the American Cleaning Institute and the Personal Care Products Council in a joint statement. "Our industry’s Topical Antimicrobial Coalition has submitted to FDA in-depth data showing that antibacterial soaps are more effective in killing germs when compared with non-antibacterial soaps," the statement said.

The groups said that they "will continue to operate in good faith to submit any new data that is available," but that manufacturers will submit comments to FDA "reaffirming that the use of antibacterial wash products in the home environment does not contribute to antibiotic or antibacterial resistance."

Consumer groups such as the NRDC, the Environmental Working Group, and others that have pressured the agency to more strictly regulate triclosan or remove it from the market applauded the FDA proposal, but noted that the examination of the ingredient has already been 30 years in the making.

Since the FDA first proposed regulating triclosan in 1978, it has revisited the topic multiple times, including at a 2005 advisory committee meeting. The panel said that the antibacterial soaps were ineffective and raised numerous safety concerns.

Mae Wu, an attorney with the NRDC’s health program, said in a statement that the agency’s proposal was "a good first step toward getting unsafe triclosan off the market."

Sen. Ed Markey (D-Mass.), who has urged the FDA to finalize its triclosan ruling and also has encouraged manufacturers to stop using it, said in a statement that "chemicals like triclosan existed in a regulatory black hole" for decades. "I applaud the FDA for taking a step to restrict the use of this harmful and ineffective chemical that continues to pollute our bodies," he said.

The FDA and the Environmental Protection Agency, among other agencies, have acknowledged triclosan’s potential to interfere with the normal functioning of estrogen, testosterone, and thyroid hormone. The National Toxicology Program continues to study the chemical, but the FDA wants manufacturers to come forward with information, too, Dr. Kweder said.

The FDA did approve the use of triclosan in Colgate Total toothpaste in 1997. The NRDC recently sued the FDA for access to its full records on that approval, saying that the ingredient should not be in toothpaste, either.

The FDA is not as concerned about the use in toothpaste, because it received data from the manufacturer showing that triclosan was safe and effective in that setting, Dr. Kweder said.

[email protected]

On Twitter @aliciaault

The Food and Drug Administration is proposing that manufacturers of antibacterial soaps prove by 2016 that the products are safe and effective, or they must be reformulated or relabeled.

The agency said it currently is looking only at consumer products. It will address antibacterial soaps used in the health care and food preparation settings separately. The proposal also does not affect alcohol-based hand sanitizers, which the agency has already recognized as generally safe and effective.

The Dec. 16 proposed rule is the result of a settlement with the Natural Resources Defense Council (NRDC). That nonprofit environmental group sued the agency in 2010 to force it to issue a final rule on a 1978 proposal to remove the antibacterial agent triclosan from certain consumer products.

The FDA now says that manufacturers will have to prove that antibacterial soaps and body washes – primarily made with triclosan and triclocarban – are safer and more effective than soap and water in preventing infection and the spread of germs. The agency estimates that at least 2,200 antibacterial soaps are on the market. Manufacturers have provided no evidence supporting their use, Dr. Sandra Kweder, deputy director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, said in a call with reporters. Those manufacturers will now be required to conduct studies to prove safety and effectiveness in humans.

There has been evidence in animal and in vitro studies that triclosan and triclocarban are endocrine disruptors, Dr. Kweder said.

With the antibacterial soaps, "there are unknowns and even a slight potential for a risk," she said. "We think consumers ought to know, and we ought to know, what the benefits of these products are."

The rule is open for comment until June 2014. The antibacterial soaps are allowed to remain on the market until the agency finalizes its proposal – not likely until September 2016, Dr. Kweder said. If manufacturers cannot demonstrate safety and effectiveness, the soaps will have to be reformulated without triclosan or relabeled to remove any antibacterial claims, Dr. Kweder said.

Manufacturers, however, said that they already have complied with agency requests for more data.

"We are perplexed that the Agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said the American Cleaning Institute and the Personal Care Products Council in a joint statement. "Our industry’s Topical Antimicrobial Coalition has submitted to FDA in-depth data showing that antibacterial soaps are more effective in killing germs when compared with non-antibacterial soaps," the statement said.

The groups said that they "will continue to operate in good faith to submit any new data that is available," but that manufacturers will submit comments to FDA "reaffirming that the use of antibacterial wash products in the home environment does not contribute to antibiotic or antibacterial resistance."

Consumer groups such as the NRDC, the Environmental Working Group, and others that have pressured the agency to more strictly regulate triclosan or remove it from the market applauded the FDA proposal, but noted that the examination of the ingredient has already been 30 years in the making.

Since the FDA first proposed regulating triclosan in 1978, it has revisited the topic multiple times, including at a 2005 advisory committee meeting. The panel said that the antibacterial soaps were ineffective and raised numerous safety concerns.

Mae Wu, an attorney with the NRDC’s health program, said in a statement that the agency’s proposal was "a good first step toward getting unsafe triclosan off the market."

Sen. Ed Markey (D-Mass.), who has urged the FDA to finalize its triclosan ruling and also has encouraged manufacturers to stop using it, said in a statement that "chemicals like triclosan existed in a regulatory black hole" for decades. "I applaud the FDA for taking a step to restrict the use of this harmful and ineffective chemical that continues to pollute our bodies," he said.

The FDA and the Environmental Protection Agency, among other agencies, have acknowledged triclosan’s potential to interfere with the normal functioning of estrogen, testosterone, and thyroid hormone. The National Toxicology Program continues to study the chemical, but the FDA wants manufacturers to come forward with information, too, Dr. Kweder said.

The FDA did approve the use of triclosan in Colgate Total toothpaste in 1997. The NRDC recently sued the FDA for access to its full records on that approval, saying that the ingredient should not be in toothpaste, either.

The FDA is not as concerned about the use in toothpaste, because it received data from the manufacturer showing that triclosan was safe and effective in that setting, Dr. Kweder said.

[email protected]

On Twitter @aliciaault

The Food and Drug Administration is proposing that manufacturers of antibacterial soaps prove by 2016 that the products are safe and effective, or they must be reformulated or relabeled.

The agency said it currently is looking only at consumer products. It will address antibacterial soaps used in the health care and food preparation settings separately. The proposal also does not affect alcohol-based hand sanitizers, which the agency has already recognized as generally safe and effective.

The Dec. 16 proposed rule is the result of a settlement with the Natural Resources Defense Council (NRDC). That nonprofit environmental group sued the agency in 2010 to force it to issue a final rule on a 1978 proposal to remove the antibacterial agent triclosan from certain consumer products.

The FDA now says that manufacturers will have to prove that antibacterial soaps and body washes – primarily made with triclosan and triclocarban – are safer and more effective than soap and water in preventing infection and the spread of germs. The agency estimates that at least 2,200 antibacterial soaps are on the market. Manufacturers have provided no evidence supporting their use, Dr. Sandra Kweder, deputy director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, said in a call with reporters. Those manufacturers will now be required to conduct studies to prove safety and effectiveness in humans.

There has been evidence in animal and in vitro studies that triclosan and triclocarban are endocrine disruptors, Dr. Kweder said.

With the antibacterial soaps, "there are unknowns and even a slight potential for a risk," she said. "We think consumers ought to know, and we ought to know, what the benefits of these products are."

The rule is open for comment until June 2014. The antibacterial soaps are allowed to remain on the market until the agency finalizes its proposal – not likely until September 2016, Dr. Kweder said. If manufacturers cannot demonstrate safety and effectiveness, the soaps will have to be reformulated without triclosan or relabeled to remove any antibacterial claims, Dr. Kweder said.

Manufacturers, however, said that they already have complied with agency requests for more data.

"We are perplexed that the Agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said the American Cleaning Institute and the Personal Care Products Council in a joint statement. "Our industry’s Topical Antimicrobial Coalition has submitted to FDA in-depth data showing that antibacterial soaps are more effective in killing germs when compared with non-antibacterial soaps," the statement said.

The groups said that they "will continue to operate in good faith to submit any new data that is available," but that manufacturers will submit comments to FDA "reaffirming that the use of antibacterial wash products in the home environment does not contribute to antibiotic or antibacterial resistance."

Consumer groups such as the NRDC, the Environmental Working Group, and others that have pressured the agency to more strictly regulate triclosan or remove it from the market applauded the FDA proposal, but noted that the examination of the ingredient has already been 30 years in the making.

Since the FDA first proposed regulating triclosan in 1978, it has revisited the topic multiple times, including at a 2005 advisory committee meeting. The panel said that the antibacterial soaps were ineffective and raised numerous safety concerns.

Mae Wu, an attorney with the NRDC’s health program, said in a statement that the agency’s proposal was "a good first step toward getting unsafe triclosan off the market."

Sen. Ed Markey (D-Mass.), who has urged the FDA to finalize its triclosan ruling and also has encouraged manufacturers to stop using it, said in a statement that "chemicals like triclosan existed in a regulatory black hole" for decades. "I applaud the FDA for taking a step to restrict the use of this harmful and ineffective chemical that continues to pollute our bodies," he said.

The FDA and the Environmental Protection Agency, among other agencies, have acknowledged triclosan’s potential to interfere with the normal functioning of estrogen, testosterone, and thyroid hormone. The National Toxicology Program continues to study the chemical, but the FDA wants manufacturers to come forward with information, too, Dr. Kweder said.

The FDA did approve the use of triclosan in Colgate Total toothpaste in 1997. The NRDC recently sued the FDA for access to its full records on that approval, saying that the ingredient should not be in toothpaste, either.

The FDA is not as concerned about the use in toothpaste, because it received data from the manufacturer showing that triclosan was safe and effective in that setting, Dr. Kweder said.

[email protected]

On Twitter @aliciaault

The Food and Drug Administration is proposing that manufacturers of antibacterial soaps prove by 2016 that the products are safe and effective, or they must be reformulated or relabeled.

The agency said it currently is looking only at consumer products. It will address antibacterial soaps used in the health care and food preparation settings separately. The proposal also does not affect alcohol-based hand sanitizers, which the agency has already recognized as generally safe and effective.

The Dec. 16 proposed rule is the result of a settlement with the Natural Resources Defense Council (NRDC). That nonprofit environmental group sued the agency in 2010 to force it to issue a final rule on a 1978 proposal to remove the antibacterial agent triclosan from certain consumer products.

The FDA now says that manufacturers will have to prove that antibacterial soaps and body washes – primarily made with triclosan and triclocarban – are safer and more effective than soap and water in preventing infection and the spread of germs. The agency estimates that at least 2,200 antibacterial soaps are on the market. Manufacturers have provided no evidence supporting their use, Dr. Sandra Kweder, deputy director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, said in a call with reporters. Those manufacturers will now be required to conduct studies to prove safety and effectiveness in humans.

There has been evidence in animal and in vitro studies that triclosan and triclocarban are endocrine disruptors, Dr. Kweder said.

With the antibacterial soaps, "there are unknowns and even a slight potential for a risk," she said. "We think consumers ought to know, and we ought to know, what the benefits of these products are."

The rule is open for comment until June 2014. The antibacterial soaps are allowed to remain on the market until the agency finalizes its proposal – not likely until September 2016, Dr. Kweder said. If manufacturers cannot demonstrate safety and effectiveness, the soaps will have to be reformulated without triclosan or relabeled to remove any antibacterial claims, Dr. Kweder said.

Manufacturers, however, said that they already have complied with agency requests for more data.

"We are perplexed that the Agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said the American Cleaning Institute and the Personal Care Products Council in a joint statement. "Our industry’s Topical Antimicrobial Coalition has submitted to FDA in-depth data showing that antibacterial soaps are more effective in killing germs when compared with non-antibacterial soaps," the statement said.

The groups said that they "will continue to operate in good faith to submit any new data that is available," but that manufacturers will submit comments to FDA "reaffirming that the use of antibacterial wash products in the home environment does not contribute to antibiotic or antibacterial resistance."

Consumer groups such as the NRDC, the Environmental Working Group, and others that have pressured the agency to more strictly regulate triclosan or remove it from the market applauded the FDA proposal, but noted that the examination of the ingredient has already been 30 years in the making.

Since the FDA first proposed regulating triclosan in 1978, it has revisited the topic multiple times, including at a 2005 advisory committee meeting. The panel said that the antibacterial soaps were ineffective and raised numerous safety concerns.

Mae Wu, an attorney with the NRDC’s health program, said in a statement that the agency’s proposal was "a good first step toward getting unsafe triclosan off the market."

Sen. Ed Markey (D-Mass.), who has urged the FDA to finalize its triclosan ruling and also has encouraged manufacturers to stop using it, said in a statement that "chemicals like triclosan existed in a regulatory black hole" for decades. "I applaud the FDA for taking a step to restrict the use of this harmful and ineffective chemical that continues to pollute our bodies," he said.

The FDA and the Environmental Protection Agency, among other agencies, have acknowledged triclosan’s potential to interfere with the normal functioning of estrogen, testosterone, and thyroid hormone. The National Toxicology Program continues to study the chemical, but the FDA wants manufacturers to come forward with information, too, Dr. Kweder said.

The FDA did approve the use of triclosan in Colgate Total toothpaste in 1997. The NRDC recently sued the FDA for access to its full records on that approval, saying that the ingredient should not be in toothpaste, either.

The FDA is not as concerned about the use in toothpaste, because it received data from the manufacturer showing that triclosan was safe and effective in that setting, Dr. Kweder said.

[email protected]

On Twitter @aliciaault

The Food and Drug Administration is proposing that manufacturers of antibacterial soaps prove by 2016 that the products are safe and effective, or they must be reformulated or relabeled.

The agency said it currently is looking only at consumer products. It will address antibacterial soaps used in the health care and food preparation settings separately. The proposal also does not affect alcohol-based hand sanitizers, which the agency has already recognized as generally safe and effective.

The Dec. 16 proposed rule is the result of a settlement with the Natural Resources Defense Council (NRDC). That nonprofit environmental group sued the agency in 2010 to force it to issue a final rule on a 1978 proposal to remove the antibacterial agent triclosan from certain consumer products.

The FDA now says that manufacturers will have to prove that antibacterial soaps and body washes – primarily made with triclosan and triclocarban – are safer and more effective than soap and water in preventing infection and the spread of germs. The agency estimates that at least 2,200 antibacterial soaps are on the market. Manufacturers have provided no evidence supporting their use, Dr. Sandra Kweder, deputy director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, said in a call with reporters. Those manufacturers will now be required to conduct studies to prove safety and effectiveness in humans.

There has been evidence in animal and in vitro studies that triclosan and triclocarban are endocrine disruptors, Dr. Kweder said.

With the antibacterial soaps, "there are unknowns and even a slight potential for a risk," she said. "We think consumers ought to know, and we ought to know, what the benefits of these products are."

The rule is open for comment until June 2014. The antibacterial soaps are allowed to remain on the market until the agency finalizes its proposal – not likely until September 2016, Dr. Kweder said. If manufacturers cannot demonstrate safety and effectiveness, the soaps will have to be reformulated without triclosan or relabeled to remove any antibacterial claims, Dr. Kweder said.

Manufacturers, however, said that they already have complied with agency requests for more data.

"We are perplexed that the Agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said the American Cleaning Institute and the Personal Care Products Council in a joint statement. "Our industry’s Topical Antimicrobial Coalition has submitted to FDA in-depth data showing that antibacterial soaps are more effective in killing germs when compared with non-antibacterial soaps," the statement said.

The groups said that they "will continue to operate in good faith to submit any new data that is available," but that manufacturers will submit comments to FDA "reaffirming that the use of antibacterial wash products in the home environment does not contribute to antibiotic or antibacterial resistance."

Consumer groups such as the NRDC, the Environmental Working Group, and others that have pressured the agency to more strictly regulate triclosan or remove it from the market applauded the FDA proposal, but noted that the examination of the ingredient has already been 30 years in the making.

Since the FDA first proposed regulating triclosan in 1978, it has revisited the topic multiple times, including at a 2005 advisory committee meeting. The panel said that the antibacterial soaps were ineffective and raised numerous safety concerns.

Mae Wu, an attorney with the NRDC’s health program, said in a statement that the agency’s proposal was "a good first step toward getting unsafe triclosan off the market."

Sen. Ed Markey (D-Mass.), who has urged the FDA to finalize its triclosan ruling and also has encouraged manufacturers to stop using it, said in a statement that "chemicals like triclosan existed in a regulatory black hole" for decades. "I applaud the FDA for taking a step to restrict the use of this harmful and ineffective chemical that continues to pollute our bodies," he said.

The FDA and the Environmental Protection Agency, among other agencies, have acknowledged triclosan’s potential to interfere with the normal functioning of estrogen, testosterone, and thyroid hormone. The National Toxicology Program continues to study the chemical, but the FDA wants manufacturers to come forward with information, too, Dr. Kweder said.

The FDA did approve the use of triclosan in Colgate Total toothpaste in 1997. The NRDC recently sued the FDA for access to its full records on that approval, saying that the ingredient should not be in toothpaste, either.

The FDA is not as concerned about the use in toothpaste, because it received data from the manufacturer showing that triclosan was safe and effective in that setting, Dr. Kweder said.

[email protected]

On Twitter @aliciaault

Changes designed to make it easier for consumers to buy insurance through the health insurance exchanges address some concerns raised by physicians.

In a rule issued Dec. 12, the Health and Human Services department formalized a requirement that insurers give consumers until Dec. 23 to choose a health insurance plan and until midnight Dec. 31 to pay for it, in order to be considered covered on Jan. 1. State exchanges can set their own rules about Jan. 1 coverage dates, and in some cases, already have, Chiquita Brooks-Lasure, policy director for the HHS center for consumer information and insurance oversight, said during a press briefing.

Some states may elect to allow payment later than Dec. 31, she said. The HHS is asking insurers to consider accepting payment after Jan. 1 and retroactively cover services. Ms. Brooks-Lasure said that Aetna has already said it will accept payment until Jan. 8.

Insurers are also being asked to accept partial payment for the first month’s premium. Payment flexibility "will reduce the risk that patients will start the year without coverage," said Bob Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.

The agency is also "strongly encouraging" insurers to consider out-of-network providers as in network and to pay for prescription refills even if the drug is not covered under its plan – at least for the month of January.

The request has precedents, Michael Hash, director of the HHS office of health reform, said during the briefing. "This transition opportunity is quite common in the insurance world."

Mr. Doherty said the ACP hopes that "the insurance industry does its part to help ease the transition, especially by allowing patients who are in a course of treatment to keep seeing their doctors even when they are not in the plan’s network and to continue to get the drugs prescribed for them if not on the plan’s formulary."

Physician groups have asked that such a transition period be considered. At a White House meeting on Nov. 26, they expressed concern that patients in the midst of expensive or specialized treatment might experience a major disruption in care if forced to give up a particular physician or therapy when switching to a new plan.

Mr. Hash said insurers were open to accommodating new enrollees. He said the HHS and insurance companies are working together to "make sure that everyone seeking coverage effective Jan. 1 gets coverage."

The HHS also announced on Dec. 12 that the almost 86,000 individuals in the federal high-risk pool, known as the Pre-Existing Condition Insurance Plan (PCIP), have had their coverage extended to Jan. 31. Those policies had been set to expire Dec. 31.

The program has had its share of financial troubles, and in February, the HHS temporarily stopped enrolling new patients. House Republicans charged that the PCIP had been mismanaged and sought to give it more money. That never happened. On the call with reporters, Ms. Brooks Lasure said the program had spent only $4.74 billion of the $5 billion allotted to it under the Affordable Care Act (ACA), and thus, could afford to pay for the additional month.

The American Cancer Society Cancer Action Network (ACSCAN) applauded the PCIP extension. "Extending coverage under PCIP gives patients valuable additional time to select the marketplace plan that best meets their unique needs," ACSCAN president Chris Hansen said in a statement.

House Republicans, however, portrayed the PCIP policy change as "another delay" in ACA implementation. "The administration has known for many months that this law was not ready for prime time, and Americans who depend on high-risk pools would have been better served by the administration admitting their failures sooner and working with the Congress to protect these and other Americans being harmed by the health care law," House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement.

[email protected]

On Twitter @aliciaault

Changes designed to make it easier for consumers to buy insurance through the health insurance exchanges address some concerns raised by physicians.

In a rule issued Dec. 12, the Health and Human Services department formalized a requirement that insurers give consumers until Dec. 23 to choose a health insurance plan and until midnight Dec. 31 to pay for it, in order to be considered covered on Jan. 1. State exchanges can set their own rules about Jan. 1 coverage dates, and in some cases, already have, Chiquita Brooks-Lasure, policy director for the HHS center for consumer information and insurance oversight, said during a press briefing.

Some states may elect to allow payment later than Dec. 31, she said. The HHS is asking insurers to consider accepting payment after Jan. 1 and retroactively cover services. Ms. Brooks-Lasure said that Aetna has already said it will accept payment until Jan. 8.

Insurers are also being asked to accept partial payment for the first month’s premium. Payment flexibility "will reduce the risk that patients will start the year without coverage," said Bob Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.

The agency is also "strongly encouraging" insurers to consider out-of-network providers as in network and to pay for prescription refills even if the drug is not covered under its plan – at least for the month of January.

The request has precedents, Michael Hash, director of the HHS office of health reform, said during the briefing. "This transition opportunity is quite common in the insurance world."

Mr. Doherty said the ACP hopes that "the insurance industry does its part to help ease the transition, especially by allowing patients who are in a course of treatment to keep seeing their doctors even when they are not in the plan’s network and to continue to get the drugs prescribed for them if not on the plan’s formulary."

Physician groups have asked that such a transition period be considered. At a White House meeting on Nov. 26, they expressed concern that patients in the midst of expensive or specialized treatment might experience a major disruption in care if forced to give up a particular physician or therapy when switching to a new plan.

Mr. Hash said insurers were open to accommodating new enrollees. He said the HHS and insurance companies are working together to "make sure that everyone seeking coverage effective Jan. 1 gets coverage."

The HHS also announced on Dec. 12 that the almost 86,000 individuals in the federal high-risk pool, known as the Pre-Existing Condition Insurance Plan (PCIP), have had their coverage extended to Jan. 31. Those policies had been set to expire Dec. 31.

The program has had its share of financial troubles, and in February, the HHS temporarily stopped enrolling new patients. House Republicans charged that the PCIP had been mismanaged and sought to give it more money. That never happened. On the call with reporters, Ms. Brooks Lasure said the program had spent only $4.74 billion of the $5 billion allotted to it under the Affordable Care Act (ACA), and thus, could afford to pay for the additional month.

The American Cancer Society Cancer Action Network (ACSCAN) applauded the PCIP extension. "Extending coverage under PCIP gives patients valuable additional time to select the marketplace plan that best meets their unique needs," ACSCAN president Chris Hansen said in a statement.

House Republicans, however, portrayed the PCIP policy change as "another delay" in ACA implementation. "The administration has known for many months that this law was not ready for prime time, and Americans who depend on high-risk pools would have been better served by the administration admitting their failures sooner and working with the Congress to protect these and other Americans being harmed by the health care law," House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement.

[email protected]

On Twitter @aliciaault

Changes designed to make it easier for consumers to buy insurance through the health insurance exchanges address some concerns raised by physicians.

In a rule issued Dec. 12, the Health and Human Services department formalized a requirement that insurers give consumers until Dec. 23 to choose a health insurance plan and until midnight Dec. 31 to pay for it, in order to be considered covered on Jan. 1. State exchanges can set their own rules about Jan. 1 coverage dates, and in some cases, already have, Chiquita Brooks-Lasure, policy director for the HHS center for consumer information and insurance oversight, said during a press briefing.

Some states may elect to allow payment later than Dec. 31, she said. The HHS is asking insurers to consider accepting payment after Jan. 1 and retroactively cover services. Ms. Brooks-Lasure said that Aetna has already said it will accept payment until Jan. 8.

Insurers are also being asked to accept partial payment for the first month’s premium. Payment flexibility "will reduce the risk that patients will start the year without coverage," said Bob Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.

The agency is also "strongly encouraging" insurers to consider out-of-network providers as in network and to pay for prescription refills even if the drug is not covered under its plan – at least for the month of January.

The request has precedents, Michael Hash, director of the HHS office of health reform, said during the briefing. "This transition opportunity is quite common in the insurance world."

Mr. Doherty said the ACP hopes that "the insurance industry does its part to help ease the transition, especially by allowing patients who are in a course of treatment to keep seeing their doctors even when they are not in the plan’s network and to continue to get the drugs prescribed for them if not on the plan’s formulary."

Physician groups have asked that such a transition period be considered. At a White House meeting on Nov. 26, they expressed concern that patients in the midst of expensive or specialized treatment might experience a major disruption in care if forced to give up a particular physician or therapy when switching to a new plan.

Mr. Hash said insurers were open to accommodating new enrollees. He said the HHS and insurance companies are working together to "make sure that everyone seeking coverage effective Jan. 1 gets coverage."

The HHS also announced on Dec. 12 that the almost 86,000 individuals in the federal high-risk pool, known as the Pre-Existing Condition Insurance Plan (PCIP), have had their coverage extended to Jan. 31. Those policies had been set to expire Dec. 31.

The program has had its share of financial troubles, and in February, the HHS temporarily stopped enrolling new patients. House Republicans charged that the PCIP had been mismanaged and sought to give it more money. That never happened. On the call with reporters, Ms. Brooks Lasure said the program had spent only $4.74 billion of the $5 billion allotted to it under the Affordable Care Act (ACA), and thus, could afford to pay for the additional month.

The American Cancer Society Cancer Action Network (ACSCAN) applauded the PCIP extension. "Extending coverage under PCIP gives patients valuable additional time to select the marketplace plan that best meets their unique needs," ACSCAN president Chris Hansen said in a statement.

House Republicans, however, portrayed the PCIP policy change as "another delay" in ACA implementation. "The administration has known for many months that this law was not ready for prime time, and Americans who depend on high-risk pools would have been better served by the administration admitting their failures sooner and working with the Congress to protect these and other Americans being harmed by the health care law," House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement.

[email protected]

On Twitter @aliciaault

WASHINGTON – Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year’s end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.

In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.

The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.

The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.

Although physician groups aren’t thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.

Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.

Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.

"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.

Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.

The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.

"This may not be the final step, it’s a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.

The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.

The Senate Finance Committee also did not include a way to pay for repeal in its proposal.

The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.

Sen. Orrin Hatch (R- Utah), the committee’s top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.

"This bill will be offset, period, or it’s not going to go through both houses," he said. "This bill will be paid for."

The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.

Physician groups praised the continued congressional action.

The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare’s failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."

The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.

"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."

The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."

"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.

Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.

"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn’t add one dime to our nation’s debt."

[email protected]

[email protected]

WASHINGTON – Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year’s end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.

In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.

The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.

The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.

Although physician groups aren’t thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.

Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.

Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.

"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.

Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.

The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.

"This may not be the final step, it’s a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.

The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.

The Senate Finance Committee also did not include a way to pay for repeal in its proposal.

The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.

Sen. Orrin Hatch (R- Utah), the committee’s top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.

"This bill will be offset, period, or it’s not going to go through both houses," he said. "This bill will be paid for."

The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.

Physician groups praised the continued congressional action.

The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare’s failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."

The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.

"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."

The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."

"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.

Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.

"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn’t add one dime to our nation’s debt."

[email protected]

[email protected]

WASHINGTON – Congress has moved the ball forward on permanently replacing the Medicare Sustainable Growth Rate formula, but with time short for a fix by year’s end the House has voted to approve a temporary 3-month reprieve from the 20% cut due to take effect Jan. 1.

In a 332-94 vote, with eight abstentions, the House on Dec. 12 approved the Bipartisan Budget Act of 2013, a wide-ranging budget agreement that includes the 3-month patch. The bill also would increase physician pay by 0.5% through March.

The Congressional Budget Office estimated that the temporary fix would cost $3.3 billion in 2014 and a total of $7.3 billion through 2023. The fix would be paid for by cutting Medicaid payments for hospital-based charity care and to long-term care hospitals.

It also would extend the 2% sequestration cuts for Medicare providers by 2 years, from 2021 to 2023.

The Senate has yet to consider the budget package including the SGR patch; it is expected to do so before its holiday recess. President Obama has said that he supports the deal.

The agreement, brokered by House Budget Committee Chairman Paul Ryan (R-Wisc.) and Senate Budget Committee Chairman Patty Murray (D-Wash.), adds about $63 billion in discretionary federal spending over 2 years and makes targeted cuts and fee hikes to bring about overall deficit reduction of about $23 billion.

Although physician groups aren’t thrilled about the continuation of the Medicare cuts under sequestration, most favor the temporary SGR reprieve and the restoration of some funding to federal health programs.

Dr. Ardis Dee Hoven, president of the American Medical Association, said that the continuation of the sequester cuts in Medicare is "frustrating" and poses the risk of destabilizing physician practices. "The concept of the sequester is probably not the best way to rein in spending," she said.

Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, praised the agreement for providing funds that could restore cuts in medical research and cancer care at the National Institutes of Health. He expressed disappointment, however, that the bill does not reverse cuts to Medicare, including reductions in the payments for physician-administered drugs under Medicare Part B.

"Oncologists are doing everything possible to continue providing care for Medicare patients, but this reduction has forced many in private practice to send patients to hospitals for chemotherapy because they cannot afford to administer these drugs in their office," Dr. Hudis said in a statement.

Physician organizations viewed the patch as necessary while Congress continues to work on a permanent SGR fix. Both the House and Senate took steps toward that goal on Dec. 12.

The House Ways and Means Committee voted 39-0 to approve its replacement proposal, which essentially adds on to the bill approved by the House Energy and Commerce Committee in July.

"This may not be the final step, it’s a very important step forward," said Rep. Kevin Brady (R-Tex.), chairman of the Ways and Means Health Subcommittee.

The House did not address how to pay for the permanent replacement. House Ways and Means Chairman Dave Camp (R-Mich.) noted that the Congressional Budget Office has estimated that it will cost $116 billion over 10 years to repeal the SGR, which is "more than half the cost 2 years ago." Even though that is the lowest estimate ever, "I am of no illusion that finding pay-fors will be an easy task," he said.

The Senate Finance Committee also did not include a way to pay for repeal in its proposal.

The bill had widespread bipartisan support in the committee, but some Senators raised concerns about the lack of a funding mechanism. Sen. Pat Roberts (R-Kan.) said that he wouldn’t support the bill until he could see how it would be funded.

Sen. Orrin Hatch (R- Utah), the committee’s top-ranking Republican, said that the offsets would be worked out once the bill had cleared the initial policymaking phase.

"This bill will be offset, period, or it’s not going to go through both houses," he said. "This bill will be paid for."

The panel agreed to add a provision aimed at expanding access to community mental health services. The amendment, offered by Sen. Debbie Stabenow (D-Mich.) and Sen. Roy Blunt (R-Mo.), would create pilot programs in 10 states to ensure that community behavioral health clinics offer a full range of mental health services, including 24-hour crisis care, substance abuse treatment, and expanded support for families.

Physician groups praised the continued congressional action.

The AMA "strongly commends members of the House Ways and Means Committee and the Senate Finance Committee for the tremendous progress they have made toward repealing Medicare’s failed Sustainable Growth Rate (SGR) formula and creating a stronger Medicare program," Dr. Hoven said in a statement. "The AMA will continue to work collaboratively with Congress so that a bipartisan agreement can be signed into law early next year to repeal the failed SGR payment formula."

The American College of Physicians said that it, too, would work to ensure that a bill moves through Congress and gets to the White House for approval soon.

"The bills reported today ... will help ensure that Medicare patients continue to have access to their physicians," said Dr. Charles Cutler, chairman of the ACP Board of Regents. "Their efforts will work to stabilize payments, provide multiple pathways for physicians to qualify for positive updates and to participate in alternative payment models, create positive incentives for patient-centered medical homes, provide assistance to small practices, and needed funding for development of quality measures."

The American College of Cardiology said in a statement that the proposals accomplished two of its highest priorities: eliminating the SGR and including provisions that will emphasize quality of care, including "provisions that emphasize the importance of clinical data registries, quality measure development, and appropriate use criteria to promote evidence-based care."

"We caution that our final support rests upon the caveat that paying for this legislation must not cause harm to patients and the physicians who care for them," Dr. John Gordon Harold, ACC president, said in the statement.

Legislators from the Finance Committee and the Ways and Means Committee celebrated their votes in a joint statement. In the statement, Sen. Hatch also issued a word of caution.

"Now that this legislation moves out of Committee and onto the floor, we need to continue to work together to ensure that this smart policy becomes law and ensure that it doesn’t add one dime to our nation’s debt."

[email protected]

[email protected]

WASHINGTON – Congress is preparing to vote on a proposal that would give physicians a temporary 3-month reprieve from the 20% Medicare pay cut that’s due to take effect on Jan. 1.

The proposal was quickly attached to legislation federal budget legislation that would also ameliorate some of the automatic, across-the-board spending cuts known as sequestration.

The House is scheduled to vote on the budget measure before it leaves for a month-long recess on Dec. 13. It is expected that the "doc fix" proposal could be voted on within the same time frame; however, it may not get support of the full House, even though there is bipartisan consensus to replace the Sustainable Growth Rate formula.

At a House Rules Committee hearing on Dec. 11, Democratic leaders said that they would not support the temporary SGR patch unless Republicans agreed to also vote on restoring unemployment compensation benefits for 3 months. Those benefits are due to expire at the end of December for 1.3 million Americans.

"I’m not sure that Democrats can vote for a package that adds SGR, which we support, but does not allow us to address long-term unemployment," said Rep. Nita Lowey (D-N.Y.).

The SGR amendment would increase physician fees by 0.5% for January-March 2014 and encourage Congress to keep working on a new, permanent Medicare fee system teamed with reduced administrative burdens and timely feedback on performance and to develop new payment models.

The temporary fix would be paid for by adjusting disproportionate share payments for hospitals, according to Rep. Michael Burgess (R-Tex.), an ob.gyn. who serves on the Rules Committee. The payment mechanism is noncontroversial, he said in an interview.

Physician groups have said that they would support a short-term fix, provided lawmakers continue working on a permanent repeal of the SGR.

"This is simply a pathway," Dr. Ardis Dee Hoven, president of the American Medical Association, said in an interview. "We want to keep up the momentum to get the SGR repealed. We recognize that it’s going to take a little more time."

Dr. Molly Cooke, president of the American College of Physicians, agreed. "This measure will allow Congress time to complete work early next year on comprehensive legislation to repeal the Medicare SGR formula," she said in a statement.

The Senate Finance Committee and the House Ways and Means Committee are both meeting to vote on proposals to permanently replace the SGR on Dec. 12.

[email protected]

On Twitter @aliciaault

WASHINGTON – Congress is preparing to vote on a proposal that would give physicians a temporary 3-month reprieve from the 20% Medicare pay cut that’s due to take effect on Jan. 1.

The proposal was quickly attached to legislation federal budget legislation that would also ameliorate some of the automatic, across-the-board spending cuts known as sequestration.

The House is scheduled to vote on the budget measure before it leaves for a month-long recess on Dec. 13. It is expected that the "doc fix" proposal could be voted on within the same time frame; however, it may not get support of the full House, even though there is bipartisan consensus to replace the Sustainable Growth Rate formula.

At a House Rules Committee hearing on Dec. 11, Democratic leaders said that they would not support the temporary SGR patch unless Republicans agreed to also vote on restoring unemployment compensation benefits for 3 months. Those benefits are due to expire at the end of December for 1.3 million Americans.

"I’m not sure that Democrats can vote for a package that adds SGR, which we support, but does not allow us to address long-term unemployment," said Rep. Nita Lowey (D-N.Y.).

The SGR amendment would increase physician fees by 0.5% for January-March 2014 and encourage Congress to keep working on a new, permanent Medicare fee system teamed with reduced administrative burdens and timely feedback on performance and to develop new payment models.

The temporary fix would be paid for by adjusting disproportionate share payments for hospitals, according to Rep. Michael Burgess (R-Tex.), an ob.gyn. who serves on the Rules Committee. The payment mechanism is noncontroversial, he said in an interview.

Physician groups have said that they would support a short-term fix, provided lawmakers continue working on a permanent repeal of the SGR.

"This is simply a pathway," Dr. Ardis Dee Hoven, president of the American Medical Association, said in an interview. "We want to keep up the momentum to get the SGR repealed. We recognize that it’s going to take a little more time."

Dr. Molly Cooke, president of the American College of Physicians, agreed. "This measure will allow Congress time to complete work early next year on comprehensive legislation to repeal the Medicare SGR formula," she said in a statement.

The Senate Finance Committee and the House Ways and Means Committee are both meeting to vote on proposals to permanently replace the SGR on Dec. 12.

[email protected]

On Twitter @aliciaault

WASHINGTON – Congress is preparing to vote on a proposal that would give physicians a temporary 3-month reprieve from the 20% Medicare pay cut that’s due to take effect on Jan. 1.

The proposal was quickly attached to legislation federal budget legislation that would also ameliorate some of the automatic, across-the-board spending cuts known as sequestration.

The House is scheduled to vote on the budget measure before it leaves for a month-long recess on Dec. 13. It is expected that the "doc fix" proposal could be voted on within the same time frame; however, it may not get support of the full House, even though there is bipartisan consensus to replace the Sustainable Growth Rate formula.

At a House Rules Committee hearing on Dec. 11, Democratic leaders said that they would not support the temporary SGR patch unless Republicans agreed to also vote on restoring unemployment compensation benefits for 3 months. Those benefits are due to expire at the end of December for 1.3 million Americans.

"I’m not sure that Democrats can vote for a package that adds SGR, which we support, but does not allow us to address long-term unemployment," said Rep. Nita Lowey (D-N.Y.).

The SGR amendment would increase physician fees by 0.5% for January-March 2014 and encourage Congress to keep working on a new, permanent Medicare fee system teamed with reduced administrative burdens and timely feedback on performance and to develop new payment models.

The temporary fix would be paid for by adjusting disproportionate share payments for hospitals, according to Rep. Michael Burgess (R-Tex.), an ob.gyn. who serves on the Rules Committee. The payment mechanism is noncontroversial, he said in an interview.

Physician groups have said that they would support a short-term fix, provided lawmakers continue working on a permanent repeal of the SGR.

"This is simply a pathway," Dr. Ardis Dee Hoven, president of the American Medical Association, said in an interview. "We want to keep up the momentum to get the SGR repealed. We recognize that it’s going to take a little more time."

Dr. Molly Cooke, president of the American College of Physicians, agreed. "This measure will allow Congress time to complete work early next year on comprehensive legislation to repeal the Medicare SGR formula," she said in a statement.

The Senate Finance Committee and the House Ways and Means Committee are both meeting to vote on proposals to permanently replace the SGR on Dec. 12.

[email protected]

On Twitter @aliciaault