Since 1997, when Congress passed legislation with the dreaded “sustainable growth rate” formula, the problem of how to compensate doctors who treat Medicare patients has been a perennial issue before the House Energy and Commerce Committee and Congress as a whole.
The formula, designed to tie Medicare reimbursement to providers’ productivity, would mean sharp cuts each year if left alone. Under constant lobbying pressure from physicians, Congress has nearly always averted the cuts with short-term fixes. But a long-term solution, a dream of doctors and congressional staffers alike, has proven difficult to pay for.
This year, however, the elusive “permanent doc fix” is looking more likely. Committee Chairman Fred Upton, R-Mich., has said it is on his priority list, and Ways and Means Committee Chairman Dave Camp, R-Mich., shares that view. It was no accident that the first health care hearing of the year in Upton’s committee focused on the doc fix.
Making the timing particularly opportune, the Congressional Budget Office gave repeal an unusually low score—putting the cost of a permanent fix within closer reach. The difficulty with the doc fix, now as ever, is finding the money to pay for it. CBO’s estimated $138 billion is about half the projected cost of recent years.
Upton said he hopes to move something before August, when CBO could change the score. But with congressional leaders still angling for a larger deficit-reduction deal, it might be difficult to use any of the obvious Medicare savings opportunities in the service of a stand-alone doc fix.
The best opportunity for a permanent solution might come as part of a larger deficit-reduction deal. The details on what payment policy would replace the sustainable growth rate are still under negotiation, but committee leadership has been circulating a detailed draft proposal. And Democrats on the committee say there may be room for bipartisan cooperation.
This article appears in the April 18, 2013, edition of NJ Daily as Time Looks Right for Permanent ‘Doc Fix’.