WASHINGTON (Reuters Health) - A single sentence buried deep within the proposed budget the Bush administration sent to Congress last week is causing considerable consternation among lawmakers who oversee the Medicare program and lobbyists who represent health professionals who provide care to Medicare beneficiaries.

With the exception of managed care plans, for which the budget proposes a 6. 5% increase next year, the Bush administration declined to propose any other changes in Medicare provider payments.

Rather, the budget says administration officials will work with Congress to address the recent 5. 4% physician fee cut and other provider payment issues, but that any changes will have to be "in both the short and long term. . . budget neutral across provider payment updates."

Representatives of provider groups say that means that helping one segment of the health industry will require taking funds from another. "You've got to have new money," said Nancy Dickey, former President of the American Medical Association now President of the Texas A&M University System Health Science Center. "If you're just taking a brick from the south wall and putting it in the north wall, sooner or later the whole infrastructure is in trouble," she said.

The administration position could pit physicians against home health agencies, which are hoping Congress will again delay or cancel a 15% cut scheduled for October 1, as well as nursing homes, who have temporary payment increases they want to see extended.

Members of Congress are just as unhappy with the position. In a sharply worded letter to Health and Human Services Secretary Tommy Thompson and White House Budget Director Mitch Daniels, House Ways and Means Chairman Bill Thomas, R-Calif. , and Health Subcommittee Chair Nancy Johnson, R-Conn. , challenged the administration to provide more help.

Thomas and Johnson noted that the Medicare Payment Advisory Commission (MedPAC) is about to issue recommendations on provider payment changes "that could collectively total $174 billion over 10 years." Yet the administration's budget proposes only a total of $190 billion for all Medicare changes, with $77 billion of that earmarked for a low-income drug benefit.

"Does the administration believe Congress should address any of the problems identified by MedPAC with respect to hospitals, home health agencies, physicians, skilled nursing facilities and dialysis facilities?" the letter asked. "Please identify which provider problems you believe merit Congressional action and which do not." Because the budget requires that any new spending be offset by cuts elsewhere, the letter continues, "please provide a specific list of Medicare savings recommendations, which can finance appropriate provider payment changes."

Members of the House Energy and Commerce Committee, which shares oversight of Medicare in the House with Ways and Means, grilled Medicare administrator Tom Scully Thursday at a hearing on the physician payment problem.

Scully, however, said he is confident that "there are other places in Medicare" that could be cut in order to pay for physician fee changes and other payment policies Congress may want to make. He declined, however, to offer any specific suggestions.