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
Clara Ritger
Add to Briefcase
Clara Ritger
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 »
WOULD SERVE THROUGH 2020 ELECTION
Trump Asks McDaniel to Serve Another Term as RNC Head
1 hours ago
THE DETAILS

"As President Trump builds his team for 2020, he has asked Republican National Committee chair Ronna McDaniel to serve a second term, according to a source familiar with the conversation. The source said Trump praised McDaniel's work on behalf of the America First Agenda, effective management of the party infrastructure, and record grassroots engagement and fundraising."

Source:
INTENDS TO CALL BY MONDAY
Trump Says He'll Call MBS to Ask About Khashoggi
9 hours ago
THE LATEST

"President Trump said he plans to call Saudi Arabian King Salman bin Abdulaziz Al Saud about the disappearance of journalist Jamal Khashoggi. Trump spoke on Saturday during an appearance in the Oval Office with Pastor Andrew Brunson, who was recently released by the Turkish government."

Source:
SAYS HE TREATED HER FAIRLY
Trump on Blasey Ford: "We Won"
9 hours ago
THE LATEST

Asked by Lesley Stahl on 60 Minutes on Sunday night, President Trump said he thought he treated Dr. Christine Blasey Ford fairly, even as he was accused of poking fun of her at a rally. He then declined to address the issue further, saying "I'm not going to get into it, because we won. It doesn't matter. We won."

Source:
AUDIO OF TORTURE AND DEATH
Turkish Officials Claim To Have Video Of Khaggoshi's Killing
3 days ago
THE DETAILS

"The Turkish government has told U.S. officials that it has audio and video recordings that prove Washington Post columnist Jamal Khashoggi was killed inside the Saudi Consulate in Istanbul this month, according to U.S. and Turkish officials. The recordings show that a Saudi security team ... killed him and dismembered his body, the officials said." Late Thursday, Turkey agreed to form a joint committee with Saudi Arabia to investigate Khashoggi's disappearance, signaling Saudi Arabia's likely intent to preempt sanctions from the United States. Members of Congress have asked President Trump curb weapons sales to Saudi Arabia.

Source:
SAUDIS WERE DISCUSSING PLAN
U.S. Intel Learned of Plot to Capture Khashoggi
3 days ago
THE LATEST
×
×

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