New "Doc Fix" Bill A Grudging Compromise
By Christine Kern, contributing writer
New House SGR Legislation has fighting chance to make it through Senate
The latest bill introduced March 26 by House Speaker John Boehner hasn’t made anyone jump up and down for joy, but both sides seem to be grudgingly accepting the inevitable. With a divided Congress that has bickered over funding of a permanent fix to the vexing SGR issue, most lawmakers have come to accept that another patch is the best solution they will reach this year.
According to Inside Health Policy, the House's 12-month SGR-patch bill includes a 0.5 percent pay increase for the rest of this year, other Medicare extenders and it pays the roughly $20 billion cost with a nursing home readmissions program; pay cuts to laboratories, dialysis facilities, radiology and physician-billing codes; a $2.3 billion SGR fund left over from military pension legislation; and an extension to sequestration and disproportionate share hospital payment cuts.
Significantly, the legislation also includes a delay of the hospital two-midnights rule and ICD-10; funding for pediatric quality measures, elimination of a cap on deductibles for employer-sponsored plans; a study on children's-hospital GME; a change to California geographic-pay adjustments; a mental health demonstration; and grants for an outpatient mental health program.
The one-year patch delays yet again any tough decisions on how to pay for permanent repeal and replacement of Medicare's unpopular SGR formula for physician payments. Funding the SGR repeal has been a major sticking point, since finding the money to cover the costs of payouts is a difficult task.
As Modern Healthcare reports, advocates of responsible budgeting pointed out that a large chunk of the roughly $20 billion cost is paid for through a budgeting sleight-of-hand that doesn't actually save any money in the long run. Supporters of finally ending the decade-long practice of instituting stopgap measures to delay the SGR cuts, including new Senate Finance Chair Ron Wyden (D-OR), complained that this measure does not in fact fix the issue for once and for all. Even doctors – who face a potential 24 percent cut in Medicare reimbursements April 1 if a deal isn't cut – were displeased with the deal.
And the American Medical Association, the largest trade group for physicians, immediately called for House members to vote against the bill when it comes up for an expected floor vote Thursday. AMA President Dr. Ardis Dee Hoven argued in a statement posted by the AMA, “By extending the Medicare provider sequester and 'cherry picking' a number of cost savings provisions included in the bipartisan, bicameral framework, the (bill) actually undermines future passage of the permanent repeal framework.”
It is most likely that the Republican-controlled House and the Democratic-controlled Senate will hold their noses and back the measure. The biggest wildcard is Wyden, who wasn't a party to the bi-partisan deal that was reached last month to permanently fix the Medicare reimbursement problem. It's widely anticipated that Wyden will still bring forth his own bill to pay for a permanent doc fix, but ultimately acquiesce to the deal that's been cooked between Boehner and Senate Majority Leader Harry Reid.