Doctors Are Tired of Being ‘Fixed’ by Congress

Congress got close to replacing Medicare’s payment formula but fell back on yet another short-term patch.

MIAMI, FL - FEBRUARY 21: Dr. Martha Perez examines Maria Lebron in a room at the Community Health of South Florida, Doris Ison Health Center on February 21, 2013 in Miami, Florida. Florida Gov. Rick Scott reversed himself on February 20, and now is callling for an expansion of Medicaid to Florida residents under the federal Affordable Care Act. (Photo by Joe Raedle/Getty Images)
National Journal
Clara Ritger
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Clara Ritger
March 31, 2014, 8:21 a.m.

Doc­tors’ groups are not happy about Cap­it­ol Hill law­makers’ in­ab­il­ity to reach agree­ment on Medi­care pay­ments.

The Sen­ate voted 64-35 to pass an­oth­er short-term “doc fix” on Monday, delay­ing a 24 per­cent cut in Medi­care’s pay­ments to doc­tors. The one-year patch squeaked through the House last week in a voice vote that many mem­bers didn’t even know was hap­pen­ing.

And doc­tors’ lob­by­ing as­so­ci­ations aren’t happy about it. They had high hopes for a solu­tion that would per­man­ently re­place Medi­care’s pay­ment sys­tem.

“The phys­i­cian com­munity made some tough choices and com­prom­ises,” a rep­res­ent­at­ive at one phys­i­cians’ or­gan­iz­a­tion said. “And we didn’t really see the same ef­fort put for­ward on the pay-fors. Frankly, I think that there was a re­luct­ance on both sides of the aisle — on both sides of the Cap­it­ol — to make pro­vider cuts, re­luct­ance to make those choices pri­or to the elec­tion.”

Since 2003, Con­gress has passed 16 “doc fixes” to stop auto­mat­ic cuts put in place by the Sus­tain­able Growth Rate for­mula used to de­term­ine Medi­care phys­i­cians’ pay.

The Sen­ate’s vote is widely viewed among the doc­tor com­munity as the dis­ap­point­ing con­clu­sion of a long, bi­par­tis­an, bicam­er­al ef­fort to come to agree­ment on a long-term re­peal and re­place­ment of that for­mula. Law­makers and in­terest groups reached an agree­ment on the sub­stance of a new pay­ment for­mula, but they couldn’t agree on how to off­set the bill’s roughly $140 bil­lion price tag.

“Too many in Con­gress lacked the cour­age and where­with­al to per­man­ently fix Medi­care to im­prove care for pa­tients and provide great­er cer­tainty for phys­i­cian prac­tices,” Ar­d­is Dee Hov­en, pres­id­ent of the Amer­ic­an Med­ic­al As­so­ci­ation, said in an email. “Con­gres­sion­al lead­er­ship had to re­sort to trick­ery to pass an SGR patch that was op­posed by phys­i­cians.”

The AMA, along with more than 80 oth­er doc­tors’ groups, sent a let­ter to House lead­er­ship con­demning the short-term fix.

What a short-term patch means for the le­gis­la­tion that would per­man­ently re­peal and re­place the SGR for­mula is un­clear: Mem­bers of Con­gress could sit back down to the ne­go­ti­at­ing table in the fall, after the midterm elec­tions, when they are fa­cing no guil­lot­ine if they make un­pop­u­lar cuts to pay for the bill.

This story was up­dated at 7 p.m. East­ern to in­clude the Sen­ate vote count.

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