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NARR: A missed deadline and a big fee cut. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Physicians are looking at a temporary stop in Medicare payments for the next two weeks, thanks to a failure in Congress to act by a March 1st deadline. Medicare fees were due to be cut 21% on that day. Lawmakers have tried several times to change the formula dictating the cuts, that formula is called the sustainable growth rate. The House came close again before the weekend, passing a bill that would put the cuts on hold for one month. But Republican Senator Jim Bunning of Kentucky blocked that proposal. Legislators now have to find another way to fix the reimbursement problem. .

NARR: Meanwhile, physicians are angry that they've been left again with an uncertain pay rate. Dr. Joseph Stubbs, president of the American College of Physicians, said the consequences may be dire.

STUBBS AX: "Physicians are for the most part, I think, tired of having to deal with this inconsistency and lack of a solution year after year after year and I think what you're going to be seeing is a number of physicians are simply going to say that until Congress fixes the situation they will not be accepting new Medicare patients."

NARR: Anger was also on display at President Obama's long-awaited health summit last week. The president didn't appear to convince any Republicans to join Democrats in supporting the current health reform bills. Here's Joyce Frieden with more.

JOYCE: The 7-hour session began with the President urging the participants to listen and not just try to score political points. But the 36 House and Senate leaders still spent much of their time playing to their bases. Tennessee Republican Senator Lamar Alexander asked Democrats to start over and to forsake reconciliation. North Dakota Democratic Senator Kent Conrad tried to stir up enthusiasm for his side, saying that if Congress did nothing, it would endanger Medicare. One glimmer of compromise appeared when Republican Senator Mike Enzi of Wyoming said that although no health plan offered in a health insurance exchange should be required to meet any coverage standards, the federal government could still develop suggested minimum standards and then designate which plans met them. But by the end of the day, President Obama was forced to admit that there was no agreement on a central tenet: how to cover the 30 million uninsured, as well as the insured who have preexisting conditions but are gradually being priced out of the market.

NARR: Democrats and Republicans in the House did then put aside some differences to deal blow to the health insurance industry. In a 406 to 19 vote, the chamber stripped health plans of their exemption from antitrust laws. The bill's supporters said the move made good common sense and would make health plans more accountable. But America's Health Insurance Plans, the lobbying arm of the health insurance industry, said the bill is aimed at stopping abuses like price fixing, that are already prohibited. The group also said the bill could have unintended consequences like preventing health plans from working together to reduce paperwork and improve quality. The antitrust issue has yet to be addressed in the Senate.

NARR: Insurance companies meanwhile will be on the hot seat again this week. The administration has invited CEOs from five large health plans to come to Washington on March 3 to talk about insurance premiums and health reform. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: It's the deadline for Medicare payments to physicians. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Physicians are anxiously awaiting congressional action this week. Unless the House and Senate act, doctors will be hit with a 21% reduction in Medicare fees on March 1st. The American College of Physicians says Capitol Hill staffers have guaranteed that something will be done this week to avoid the cuts . But that promise rings hollow for ACP president Joseph Stubbs. He says doctors see Medicare's payment system as flawed, and they've given up trying to run their businesses based on temporary fixes to it.

STUBBS AX: (32:07 to 32:16, or 9 seconds) "What are we supposed to do if we're sitting there with maybe or maybe not a twenty-one percent cut and if we don't have a twenty-one percent cut for how long will we not have a twenty-one percent cut?"

NARR: Stubbs says a congressional reprieve won't make up for years of declining rates.

STUBBS AX: (32:28 to 32:41, or 12 seconds) "At best we're hoping a victory is a freeze. A freeze is zero percent increase over four or five years. It's simply untenable for the practicing physicians out there who are trying to do a good job of taking care of patients."

NARR: In the meantime, health insurers may be wishing Congress and the administration would pay a little less attention to them. The Obama administration released a report drawing attention to some of the double-digit rate increases recently sought by health plans and the massive profit those same plans are earning. Health and Human Services Secretary Kathleen Sebelius has taken the lead in hammering health plans. She said the plans' practices are just another reason the country needs reform.

Sebelius AX (18 sec.): "This kind of rate increase gives a highlight to why the President said a year ago we need to address health reform, comprehensive health reform, as part of addressing the economy. We won't fix the economy without fixing our health care system."

NARR: But America's Health Insurance Plans, the industry's main lobbying group, says that Democrats are just playing politics and that they should stop vilifying the industry. And while all of this is going on, President Obama is trying - once again -- to re-energize the push for health reform. The White House is hosting a summit on Thursday with Congressional leaders. The president released his own plan calling for health reform. His plan has a lot in common with the reform measures passed already in the House and in the Senate -- but also some changes. The president's plan throws out a special Medicaid deal for the state of Nebraska negotiated by Democratic Senator Ben Nelson in exchange for his "yes" vote on the bill. It closes the so-called "donut hole" in the Medicare prescription drug benefit, and it raises the level at which high-cost plans, or so-called "Cadillac" health plans, will be taxed. But it does not include a public option, and makes little mention of well-known proposals offered by Republicans, such as tort reform.

NARR: The half-day summit will be televised, but some critics are saying it will be little more than a chance for members of Congress to put on a show for their constitutents - that means not an opportunity to get any actual work done. Stay tuned. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: President Obama seeks compromise, not capitulation on health reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: President Obama is looking to gin up some enthusiasm for the health reform summit he's having with members of Congress later this month. In a surprise press briefing with reporters, the president said that agreeing on a basic set of facts will be step one... to reaching bipartisan compromise on a health bill.

AX Obama (36 secs.): "If it's established that by working seriously on medical malpractice and tort reform that we can reduce some of those costs, I've said from the beginning of this debate, I'd be willing to work on that. On the other hand, if I'm told that that is only a fraction of the problem and that is not the biggest driver of health care costs, then I'm also going to insist, okay, let's look at that as one aspect of it, but what else are we willing to do?.

NARR: As the administration repackages its health reform message, insurance companies are once again the target. Here's Mary Ellen Schneider with more:

Mary Ellen: It started last week when Health and Human Services Secretary Kathleen Sebelius sent a strongly worded and well publicized letter to Anthem Blue Cross demanding to know why the California health plan was raising its premiums by as much as 39%. The health plan responded by saying that healthy people are opting out of coverage leaving Anthem to cover a sicker pool of people. They added that the increases are in line with state law and affect only individuals and not group plans. Apparently, that wasn't good enough for Secretary Sebelius, who responded that Anthem's decision to raise its rates demonstrates "the urgent need for real reforms."

NARR: The House Energy and Commerce Committee is scheduled to examine Anthem's rate hike at a February 24th hearing. In the meantime, Congress has to find a way to prevent...or at least stall...a scheduled 21% cut to doctors Medicare payments. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The president's vision for health care...while reform waits in the wings. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: President Obama has released his proposed budget for 2011, requesting hundreds of billions of dollars for federal health programs, like Medicare, Medicaid, and the Children's Health Insurance Program. What's missing is any kind of focus on health reform. This is in stark contrast to last year, when his proposal centered on a 600 billion-dollar-plus set aside to get health reform done. This year's proposal still contains many elements that are consistent with reform and are good for doctors, says Dr. Lori Heim, president of the American Academy of Family Physicians. She praised a proposal to increase funding for the National Health Service Corps.

Heim AX: "That opens up an additional 449 opportunities for new physicians. And we know that those physicians provide care in rural and underserved areas. So I think that that's been an important part of encouraging medical students to go into primary care."

NARR: The HHS budget was also the main topic on Capitol Hill last week. Senate Finance Committee Chairman Max Baucus said that he was pleased that President Obama's proposal assumed passage of health reform. Baucus sees another plus: the budget assumes reform could cut the deficit by $150 billion over the next ten years. Baucus urged his colleagues to continue their reform efforts. HHS Secretary Kathleen Sebelius -- emphasized that the budget did not cut Medicare payments to physicians. And she said, HHS supports an overhaul of the Medicare physician payment formula so that the yearly debate over how much to pay doctors could end.

NARR: Health reform may reduce the deficit, but it's not clear how it will affect the ever-increasing rate of health spending. The latest projections were released last week. For more on the estimates, here's Alicia Ault.

AULT: Medicare's actuaries are projecting that, barring any change, spending on health care will outpace the annual growth in the economy over the next 10 years. By 2019, the nation's $4.5 trillion health bill will make up 19% of the gross domestic product. Last year, spending took a big jump, as the recession drove growth in Medicaid enrollment. Spending also rose as more people took advantage of the government's health insurance subsidy for the unemployed. If the Congress votes to keep Medicare physician pay at 2009 levels, total health spending will grow just under 5% this year, or about a percentage point less than last year. But that outlook could change - with the passage of a reform plan, or with any change to the Medicare physician pay formula.

NARR: Health reform, or at least a piece of it, will likely be front and center on Capitol Hill next week. The House looks at repealing the anti-trust exemption for health insurance companies and medical malpractice providers. It's part of a strategy to pass smaller-and Democrats hope-more popular parts of the health reform bill to avoid losing all their momentum. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The President shifts his focus from health reform...to health INSURANCE reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: As expected, health care did come up during President Obama's State of the Union address last week....but not until about 32 minutes into the speech. Although jobs and the economy were his early focus, the President said that America still needed what he called "health insurance reform." He refrained from giving Democrats any specific direction on how to pass a bill in the wake of their recent loss of a 60-seat majority in Congress. Instead, he simply urged everyone to press on:

AX OBAMA (16 secs.): "Here's what I ask Congress, though. Don't walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let's get it done."

NARR: In his opposition response, Virginia governor Bob McDonnell said Republicans had already offered ideas for reform, including letting families and businesses buy health insurance across state lines and reforming the tort laws. He chided the Democrats, saying the huge bill was been fully read by anyone, and that was crafted behind closed doors with special interests.

NARR: A broad coalition of unions, patient advocates, and physician organizations gathered the day of the speech...urging the President and Congress to keep working. They proposed several pathways for passing a reform bill. One was for the House and Senate should finish negotiations on the Senate-passed measure and find enough compromises to win approval in the House. Or, legislators could use reconciliation, they said. That process would include reform provisions that affect the budget, but would leave out many other policy changes. Congress should find a way to bring lawmakers together, even if it takes awhile, said Dr. Jack Lewin. He's president of the American College of Cardiology.

Lewin AX: "Let's get it done this year. Let's take this year in the congress and really have...and fix and develop a greater consensus. And maybe even more of a bipartisan consensus. Certainly between the democratic party constituencies, let's get the Blue Dogs and the rest of the democratic party together on the issues."

NARR: Physicians aren't willing to wait a year, however, to fix the Medicare payment formula, known as the sustainable growth rate, or SGR. In raising the national borrowing limit last week, the Senate made a promise to set aside enough money to avoid physician fee cuts for five years. But that promise still has to gain approval in the House and then...Congress has to agree to actually spend the money. This year's 21 percent cut will go into effect March 1 unless Congress acts. And that may not happen until late February.

NARR: House Speaker Nancy Pelosi said last week that she might break off some bits of the House and Senate bills and bring them to the floor by mid-February. But she said she was not giving up on a bigger reform package. There's guaranteed to be more maneuvering this coming week. That's the Policy & Practice Podcast, I'm Todd Zwillich.