Dr. Robert Kottman and Mrs. Kottman report the following from their meeting with Congressional Staff members on Monday, November 26:

Items of discussion –

• Medicare Fee Schedule: The Senate is working on a two-year fix for the Medicare fee schedule and should be “marking” up the bill the first week of December. It was the common feeling among all the staffers talked to that there was a good chance the 10% cut will be fixed (eliminated) for this year, but because any funds that would be spent for this purpose must be taken from another program, it was doubtful that the fix will be for two years. It was even more doubtful that Congress was prepared to permanently fix the sustainable growth rate formula to avoid this annual problem with the physician fee schedule. We reminded them that Emergency Medicine physicians would have a 12% reduction as they would have a 2% reduction in their Practice Expense Factor even if there were no change to the Medicare Fee Schedule. In addition, Medicare patients who would potentially lose their primary care providers due to the cuts would most likely turn to already overcrowded Emergency Departments. All of the staffers talked to indicated that their Senator or Representative supported a fix for the Medicare fee schedule but were all aware of the problems they faced in finding funds to finance the fix. On this topic, we are cautiously optimistic that at least a one-year fix will happen. 
• Renewal of the SCHIPS program: The general feeling was that the program would be renewed but that eligibility poverty level projections needed to be set at no more than 200% to avoid another veto by the President. While the SCHIPS program is currently in limbo, the feeling among the staffers was that as soon as one of the major states ran out of funding for the program (currently estimated at 5-6 weeks) Congress would step up, make the necessary changes in the program, and that it would pass. On this topic, we are cautiously optimistic that Congress will renew the SCHIPS program. 
• ACEP access to Emergency Medical Services bill: While there was a general understanding of the need for additional funding directed to providers who furnish services in the Emergency Department due to the large number of uninsured and underinsured patients in the ED, the source of funding for the 10% "add-on" reimbursement for Medicare patient care in the ED was a major concern.  None of the Congressional staffers were willing to speculate on the chances for passage of this important legislation.