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Will Congress Do an End Run Around Berwick? Don’t Bet Against It

Philip Betbeze, for HealthLeaders Media, August 6, 2010

Hospitals, through the American Hospital Association, did all they could to derail the 2.9% Final Inpatient Rule cuts from CMS—even enlisting the aid of a majority of senators and House members via letters protesting the cut to CMS Administrator Don Berwick. He ignored them. But they haven’t yet failed because in Washington, calling something final doesn’t mean it’s over.

Look for the AHA to try an end-run around Berwick to rescind the cuts through Congress. If they’re smart, they’ll ask the same representatives that signed their letters to come through for them again via legislation. And they are smart, if a little heavy-handed.

I’m not going to try to get into the merits of the cuts here, which go into effect for discharges occurring after Oct. 1. The two sides have agreed to disagree. Whether the cuts will harm patient care is debatable, and so is CMS’ decision to ignore the increasing severity of illness of hospital patients.

This whole disagreement might fade with time, but don’t bet on it. What we might be witnessing is the first challenge to Berwick’s authority as the healthcare cost-cutter-in-chief. Implied in the letters was a threat from representatives who, despite their protestations to the contrary, and the voting populace’s purported disgust with wasteful government spending, can’t help themselves from trying to bring home the bacon at every

opportunity. I’m no oddsmaker, but in an election year, I wouldn’t be surprised if some of those who signed the letter don’t try to override Berwick and CMS in such a way.

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