Permanent “˜Doc-Fix’ Isn’t Happening, and Short-Term Solution Isn’t Ready

Time is running out to avert a 20 percent cut in Medicare payments to doctors.

Senate Finance Committee Chairman Max Baucus(D-MT) speaks during a hearing on health insurance exchanges on November 6, 2013 in the Dirksen Senate Office on Capitol Hill in Washington, DC.
National Journal
Dec. 10, 2013, 7:50 a.m.

A per­man­ent re­peal of the Sus­tain­able Growth Rate for­mula — the flawed pay­ment mod­el for Medi­care phys­i­cians — won’t hap­pen be­fore the hol­i­day re­cess, ac­cord­ing to an of­fi­cial with the House Ways and Means Com­mit­tee.

With a per­man­ent solu­tion off the table, the House is now tasked with act­ing on a short-term “doc-fix” be­fore ad­journ­ing. If no change is made, phys­i­cians who provide ser­vices to Medi­care be­ne­fi­ciar­ies will face a 20 per­cent pay cut start­ing Jan. 1.

But though the House is slated to leave Fri­day and the Sen­ate shortly there­after, of­fi­cials in both cham­bers say the lan­guage to stop the re­im­burse­ment drop is yet to be fi­nal­ized.

Law­makers had been gun­ning for a per­man­ent solu­tion to the SGR pay­ment mod­el, which re­quires an­nu­al cuts to Medi­care re­im­burse­ments to bal­ance fed­er­al spend­ing with in­take. Since 2003, Con­gress has passed 15 “doc-fixes” to stop the cuts from tak­ing ef­fect. It’s an ex­pens­ive or­deal, adding up to a grand total of $150 bil­lion, which is why there was op­tim­ism about a per­man­ent solu­tion after the Con­gres­sion­al Budget Of­fice’s cost eval­u­ation came in re­l­at­ively low earli­er this year. On Fri­day, the cost dropped even fur­ther to $116.5 bil­lion.

But with time run­ning out, those hop­ing for a per­man­ent fix will have to settle for in­cre­ment­al pro­gress: The Sen­ate Fin­ance Com­mit­tee is sched­uled to mark up a bill aimed at an even­tu­al per­man­ent fix Thursday, and the House Ways and Means Com­mit­tee could do the same.

Draft lan­guage of the House Ways and Means ver­sion shared with Na­tion­al Journ­al in­dic­ates that the re­peal of the SGR would be re­placed by a value-based per­form­ance in­cent­ive pro­gram. Phys­i­cians’ 2013 pay­ment rates would con­tin­ue through 2023, when an an­nu­al 1 per­cent in­crease would take ef­fect (2 per­cent for phys­i­cians who par­ti­cip­ate in tests of new pay­ment mod­els).

Be­gin­ning in 2017, though, phys­i­cians’ pay­ments would be ad­jus­ted based on four per­form­ance met­rics: qual­ity of care, budget-neut­ral re­source use, mean­ing­ful use of elec­tron­ic health re­cords, and clin­ic­al-prac­tice im­prove­ment activ­it­ies. Im­prove­ment from one year to the next would be taken in­to ac­count when de­term­in­ing in­creases and de­creases in pay.

Fund­ing for value-based sys­tem will in­crease over time, from 4 per­cent of spend­ing in 2017 and max­ing out at 12 per­cent in 2021. Phys­i­cians can qual­i­fy for gains and losses less than or equal to the total spend­ing per­cent­age of that year.

The pro­pos­al also grants the Health and Hu­man Ser­vices De­part­ment the power to re­view of the cost of ser­vices, to es­tab­lish cri­ter­ia for evid­ence-based care, and to cre­ate a sys­tem for Medi­care pa­tients to re­view past per­form­ance of phys­i­cians.

What We're Following See More »
PENNSYLVANIAN WAS A CIVIL RIGHTS CRUSADER
Former Sen. Harris Wofford Dies at 92
4 hours ago
THE LATEST
ONCE MORE, WITH FEELING
McConnell Promises a Vote This Week
7 hours ago
THE LATEST
IF PELOSI DOESN'T ALLOW JAN. 29 SPEECH
Trump May Deliver SOTU Outside of Washington
7 hours ago
THE LATEST
ADMINISTRATION WANTED TO BE HEARD IN APRIL
SCOTUS May Not Hear DACA Cases This Term
9 hours ago
THE LATEST

"The federal program granting quasi-legal status and work permits to so-called Dreamers is likely to remain in effect through most of this year, after the Supreme Court appeared to rebuff President Donald Trump’s bid for quick action to resolve lawsuits over his attempt to wind down the program. Justice Department lawyers had asked the justices to accept several cases over the Deferred Action for Childhood Arrivals program and add them to the court’s calendar for argument in April, meaning a ruling could be issued by June. However, orders from the high court Tuesday morning made no mention of the DACA disputes."

Source:
AS TRUMP-KIM SUMMIT LOOMS
North Korea May Have 20 Undisclosed Missile Sites
11 hours ago
THE DETAILS

"With a second U.S.-North Korea nuclear summit looming in February, researchers have discovered a secret ballistic missile base in North Korea — one of as many as 20 undisclosed missile sites in the country, according to the researchers’ new report. The Kim regime has never disclosed the existence of the Sino-ri Missile Operating Base to the outside world. ... The report from Beyond Parallel, a project sponsored by the Center for Strategic and International Studies."

Source:
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login