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 »
PROTESTORS DEMAND ELECTIONS
Armenian Prime Minister Resigns
8 minutes ago
THE DETAILS

"Armenian Prime Minister Serzh Sargsyan has resigned following days of large-scale street protests against him." Sargsyan had previously served 10 years as President, and protestors accused him of clinging to power. "In 2015, Armenians voted in a referendum to shift the country from a presidential to a parliamentary system, stripping powers from the president and giving them to the prime minister." Sargsyan's government has also been criticized for failing to ease tensions with Azerbaijan and Turkey, and "for its close ties to Russia, whose leader Vladimir Putin also moved between the positions of president and prime minister to maintain his grip on power."

Source:
START OF THREE-DAY VISIT
French President Macron Visits White House
23 minutes ago
WHY WE CARE

President Trump "welcomes French President Emmanuel Macron the White House" today to begin a three-day state visit "expected to be dominated by U.S.-European differences on the Iran nuclear deal and souring trade relations." Trump has vowed to scrap the Iran nuclear deal "unless European allies strengthen it by mid-May." After meetings on Monday and Tuesday, Macron will address Congress on Wednesday, "the anniversary of the day that French General Charles de Gaulle addressed a Joint Session of Congress in 1960."

Source:
HIS GUNS GIVEN TO FATHER
Tennessee Waffle House Shooter Had Firearm Card Revoked
34 minutes ago
THE LATEST

"A sheriff in Illinois says Travis Reinking," the suspect in a mass shooting that killed four people in a Tennessee Waffle House on Sunday, had his state firearms card revoked last year by state police, but that "his guns were given to his father with the promise that they wouldn’t be shared with his son ... Huston says Reinking’s father has a valid firearm ownership card, and his officers didn’t believe they had any authority to seize the weapons." Police are still searching for the 29-year-old suspect.

Source:
EXPERIENCE, PROFESSIONALISM
Concerns Mounting Over Jackson’s Prospects for Confirmation
1 hours ago
THE LATEST

Senators on both sides of the aisle are beginning to sound skeptical that Ronny Jackson can be confirmed as Veterans Affairs secretary, mostly citing his lack of management experience. "Veterans groups have mostly declined to give Jackson ringing endorsements; and the White House is also aware of specific concerns about Jackson's professional conduct in the Navy that have been taken to Jon Tester in his capacity as ranking member of the Senate Veterans' Affairs Committee."

Source:
FREEZE ON TESTS ALONE AREN’T ENOUGH
Trump Will Press Kim for Rapid Nuclear Disarmament
1 hours ago
THE LATEST

"President Donald Trump will urge North Korea to act quickly to dismantle its nuclear arsenal when he meets North Korean leader Kim Jong Un and isn’t willing to grant Pyongyang substantial sanctions relief in return for a freeze of its nuclear and missile tests, administration officials said. Those two closely related questions—the pace of Pyongyang’s nuclear dismantlement and the timetable for sanctions relief—stand to be the major issues of the summit."

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