Boehner: We’ve Got a Doc Fix … for Now

With a permanent agreement stalled, Congress has a one-year plan to prevent a cut in doctors’ payments.

Speaker of the House John Boehner.
National Journal
Billy House
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Billy House
March 26, 2014, 8:58 a.m.

John Boehner says the House and Sen­ate have cut a deal on an­oth­er tem­por­ary patch to pre­vent a massive cut to doc­tors’ Medi­care pay­ments.

The bill is ex­pec­ted to be taken up in an ex­ped­ited pro­cess in the House on Thursday, as part of a non­con­tro­ver­sial sus­pen­sion cal­en­dar.

Doc­tors face a 24 per­cent cut in their Medi­care pay­ments if Con­gress doesn’t act by March 31. Medi­care’s pay­ment for­mula calls for ever-in­creas­ing cuts, which Con­gress al­ways delays. Doc­tors would rather have a new for­mula than an­oth­er stop­gap.

The House speak­er told re­port­ers Wed­nes­day that House and Sen­ate ef­forts have not con­cluded in try­ing to find a longer-term fix. He said there is bi­par­tis­an, bicam­er­al agree­ment on the path for­ward, only not yet on “how we’re ever go­ing to pay for it.”

The House passed a $137 bil­lion per­man­ent fix on March 14, which re­lied on sav­ings tied to the re­peal of the Af­ford­able Care Act in­di­vidu­al in­sur­ance man­date. But that was re­jec­ted by Demo­crats who lead the Sen­ate, and it faced a pres­id­en­tial veto threat.

The tem­por­ary, smal­ler bill in­cludes spend­ing off­sets from re­duc­tions in oth­er Medi­care spend­ing; also, some of its costs are paid for by re­align­ing se­quester sav­ings set to oc­cur in 2025 to 2024.

apor­tion of its costs.Spe­cific­ally, a por­tion of the bill’s “sav­ings” are achieved by simply shift­ing­sequester sav­ings set to oc­cur in 2025 in­to 2024, with­in the Con­gres­sion­al BudgetOf­fice’s scor­ing win­dow, but this has zero ac­tu­al im­pact on the debt

Spe­cific­ally, the Pro­tect­ing Ac­cess to Medi­care Act of 2014 would pre­vent the 24 per­cent cut in re­im­burse­ments to doc­tors who treat Medi­care pa­tients by re­pla­cing it on April 1 with ad­op­tion of a 0.5 per­cent up­date through Dec. 1. There would be no per­cent­age changes for the three months fol­low­ing that through April 1, 2015.

Along with ex­tend­ing pay­ments un­der what is form­ally known as the Medi­care Sus­tain­able Growth Rate for­mula through March of 2015, the bill also in­cludes fund­ing for vari­ous oth­er ex­pir­ing Medi­care pro­vi­sions.

Much of this is paid for though pro­vider cuts and the Medi­care se­quest­ra­tion sav­ings time shift tied to the $2.3 bil­lion set-aside for SGR in the budget deal worked out in 2013. It also delays sched­uled re­duc­tions in pay­ments to so-called dis­pro­por­tion­ate-share hos­pit­als by one year.

Oth­er Medi­care-re­lated pro­grams that would be ex­ten­ded for a year in­clude the geo­graph­ic prac­tice cost in­dex, the am­bu­lance add-on pay­ments, and the Medi­care Ad­vant­age Spe­cial Needs Pro­gram. It also ad­opts mar­ket-based private-sec­tor pay­ment rates for lab ser­vices.

The bill also ex­tends through 2015 the Spe­cial Dia­betes Pro­gram and Ab­stin­ence Edu­ca­tion and delays for one year im­ple­ment­a­tion the ICD-10 cod­ing sys­tem for dis­eases and treat­ment pro­ced­ures un­der the Medi­care pro­gram. That clas­si­fic­a­tion sys­tem is in­ten­ded to en­sure that hos­pit­als are doc­u­ment­ing the cor­rect treat­ment and pay­ments for those treat­ments.

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