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Consumer-First Energy Act of 2008 - Motion to Proceed

Floor Speech

Location: Washington, DC



Ms. STABENOW. Madam President, I rise today in support of S. 3101, the bipartisan effort introduced by our Senate Finance chairman, Senator Baucus, and the distinguished Senator from Maine, Senator Snowe, that will strengthen Medicare. This is a critically important bill that I hope we will have the support of the Senate on tomorrow to be able to proceed to and to pass.

This important legislation not only prevents harmful cuts from jeopardizing patient care, but it also sets the stage for modernizing our health care system through information technology. This is a very exciting part of this bill for me, with Senator Snowe having worked on this issue, with many other colleagues now for some time, and it is a very important step forward.

First and foremost, though, this legislation protects patients' access to their trusted physicians. If Congress does not act soon, Medicare payments to physicians and health care professionals will be cut by 10 percent--10 percent--as a result of the fatally flawed sustainable growth rate formula or, as we call it, the SGR. It is sad that we are once again going through this exercise. If I could, I would reform the flawed SGR formula once and for all. Personally, I wish to stop this process and create a new one that makes much more sense for physicians and for patients and the Medicare system. It makes no sense for us to go through this ordeal every 6 months or so and risk jeopardizing seniors' access to care when we know the kind of cuts facing physicians under Medicare would be devastating and would, in fact, directly impact access to care for those who rely on Medicare.

Physicians are the foundation of the Medicare system and our Nation's health care system, and patients of all ages depend upon our physicians for their health care services, which they provide in an outstanding way every single day. Every aspect of our health care system, from hospitals to rural health clinics, relies upon the skills and services of physicians.

When I introduced my bill, S. 2785, earlier this year on stopping the SGR cuts, I heard from countless seniors and physicians, medical group practices, and hospitals in my State, all expressing support for the effort to stop these cuts. For example, one orthopedic practice in southwest Michigan wrote me and said:

Every year we have to wait until the last minute to see if the rates will be cut or fixed. It makes it impossible to budget and project for the next year. Especially for a practice like ours, with nearly 50 percent of our patients receiving Medicare. With the uncertainty and the increases that we do get not keeping up with the cost of living, we have to err on the side of caution, which leads to job cuts.

That is certainly an ongoing issue all across my State. We certainly don't want to be seeing cuts as they relate to jobs or access under health care, compounding what is already happening in the health care system.

A radiologist in southwest Michigan reported having to close three outpatient x-ray offices over the past 5 years, and they are looking to close another one this year. A surgery center told me it had to put off investing in an EMR and was forced to freeze any wage increases and possibly lay off staff. A medical group in mid-Michigan that staffs two emergency room departments determined that the scheduled reduction would reduce its Medicare payments by nearly $175,000 a year--$175,000 a year.

If the reduction were to go into effect and this legislation is not passed, or similar legislation is not passed, the group wrote me it would be forced to reduce the workforce by either one full-time physician or two full-time physician assistants--cutting back on the availability of health care services for seniors and the disabled in my community. That is truly frightening when our emergency rooms are losing staff.

I have, for too many years, heard from hospitals and others across Michigan about the difficulty in finding physicians who are able to take Medicaid patients because the rates are so low. This is the first year I have been hearing such great concern from hospitals, from hospital emergency rooms, about Medicare, the Medicare rates being so low--without these cuts--and the inability to find physicians who are able to take those patients.

I am hopeful we can add language to S. 3101 similar to a bill I have introduced with Senator Specter to begin to address the crises facing our emergency rooms because we have a much broader issue we need to address there as well.

I am very proud of the work that over 20,000 MDs and DOs do in Michigan every single day, providing more than 1.4 million seniors and people with disabilities, and over 90,000 TRICARE beneficiaries in Michigan with high quality medical services under the Medicare Program.

If Senator Baucus's bipartisan legislation does not pass, physicians in Michigan will lose some $540 million for the care of seniors and people with disabilities over the next 18 months due to the 10-percent cut in payments for 2008 and the additional 5-percent cut for 2009. Madam President, $540 million of services, Medicare services, health care services that will not be rendered to the people in Michigan is not acceptable.

Michigan physicians are looking at cuts of more than $10 billion by 2016; $10 billion in the next 8 years as a result of this flawed formula, and 9 years of cuts. We certainly can't expect that physicians can continue to provide the same level of care if their payments are cut $540 million over the next 18 months alone. These cuts will be devastating to our seniors and access to care.

Second, the lack of a predictable and equitable Medicare payment system hinders our investment in information technology, which we all know we need to be investing in. We need physicians in hospitals and other providers to be investing in technology that not only allows people to communicate with one another--electronic medical records and e-prescribing--but allows the very latest technology so that we have the very highest quality, the ability to provide the most efficient processes of providing health care that is possibly available.

Health IT is very important to that. This bipartisan legislation recognizes the need for investing in information technology, something, as I indicated before, that I am pleased to have worked on for the last several years with Senator Snowe. This bipartisan legislation would increase the list of those sites under telehealth that would include skilled nursing facilities and dialysis centers and community mental health centers that would be able to receive reimbursement for telehealth, which is so important. I thank Senator Conrad for his leadership. I am pleased to be joining with him and others on the whole question of expanding this part of the technology of telemedicine, telehealth. In addition to improving access to care and facilities, we will see significant cost savings achieved by avoiding transporting medically fragile patients from one place to another. I am so proud, among many other advances in Michigan around health IT, telehealth is something that we have been using in rural parts of northern Michigan and the upper peninsula now for years. We have great leadership that has been developed. I am pleased to have had an opportunity to participate and see what is done that allows people in remote parts of Michigan to be able to communicate directly with physicians, with nursing staff, and so on, to receive care they need without traveling long distances. There are wonderful ways this can happen. This legislation expands the ability for people to receive telehealth services. This is important.

Additionally, this bipartisan bill moves us toward e-prescribing, a basic building block for greater adoption of health information technology. There are incentives for doctors who write prescriptions electronically, that improve both quality and efficiency. I thank Senator John Kerry and Senator John Ensign for working with me on the whole question of e-prescribing and being in a position to put this forward, and I thank Senator Baucus again for his leadership in strong support of this effort.

Again, we in Michigan have been recognized as one of the top five States in e-prescribing. We have had huge success in a regional collaborative in southeastern Michigan called SEMI, the Southeastern Michigan ePrescribing Initiative that has brought together General Motors, Ford, Chrysler, the UAW, insurers, and providers to work with consumers to be able to electronically create e-prescribing so the physician can in fact communicate directly with the pharmacy in the most accurate way with the most accurate information. We have some 2,500 physicians in southeastern Michigan who are engaged in this.

Last October, a patient safety analysis found that SEMI alerted doctors of potentially incorrect drug prescriptions that resulted in nearly 423,000 prescriptions being changed or canceled because of the information the doctor was able to receive. Possibly the physician was looking at a particular medication that had an adverse drug relationship with something else the patient was on, or maybe there were concerns about allergic reactions or other information that was helpful and gained through this process in the program through e-prescribing. SEMI also sent out more than 100,000 medication allergy alerts. When a formulary alert was presented, so physicians were alerted as to a problem with a particular drug they were thinking of prescribing, 39 percent of the time the physician changed the prescription.

Madam President, I ask unanimous consent for an additional 3 minutes.

The PRESIDING OFFICER. Without objection, it is so ordered.

Ms. STABENOW. Madam President, 39 percent of the time when the physician had more information they changed the prescription and therefore addressed safety concerns or saving the patient or the employer dollars.

In February, a physician satisfaction survey found that 9 out of 10 physicians believed that e-prescribing met or exceeded expectations. This is only one region of Michigan where it has been extremely successful. We have incentives in this bill to be able to support physicians using e-prescribing and being able to have some assistance to be able to purchase the equipment they need. I believe there are a thousand reasons why that is a great idea and one of the reasons I enthusiastically support this bill.

Third, this bill reauthorizes important rural provisions to ensure that all Americans, regardless of where they live, have access to health care. We have, in Michigan, again, many small- and mid-sized providers serving vast rural areas around our State. This is very important, to approve the payments for community health centers and ambulances and other providers who are hit by declining Medicare reimbursement--as well as high gas prices, I might add.

Finally, let me say I am very pleased that an area of the bill addresses gathering more information on health disparities regarding gender or regarding race. It is taken from language in my HEART for Women Act, to be able to gather more information for providers as to gaps where we need to be focusing more on particular kinds of services.

Many organizations such as the American Medical Association and the AARP have endorsed this bill and endorsed it strongly. I again thank Senator Baucus, as Finance chairman, for his leadership. I support fully his goal of providing this 18-month fix for physician payments as well as providing other very important incentives for the future.

This bill is very much about the future with e-prescribing and with telehealth and other information gathering. I very much hope that we, on behalf of the 44 million people who rely on Medicare, will have a very strong vote to proceed to this bill and have a strong bipartisan vote to adopt it. I am very hopeful that with a strong vote the President will decide to support this bill and sign this initiative.

It is critically important that we get this done. The physician cut is going to take place very shortly if we do not act. This bill does the right thing and moves us in the right direction as it relates to health care reform.


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