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 »
FIRST CHARGE FOR MIDTERMS
DOJ Charges Russian For Meddling In 2018 Midterms
2 hours ago
THE LATEST

"The Justice Department on Friday charged a Russian woman for her alleged role in a conspiracy to interfere with the 2018 U.S. election, marking the first criminal case prosecutors have brought against a foreign national for interfering in the upcoming midterms. Elena Khusyaynova, 44, was charged with conspiracy to defraud the United States. Prosecutors said she managed the finances of 'Project Lakhta,' a foreign influence operation they said was designed 'to sow discord in the U.S. political system' by pushing arguments and misinformation online about a host of divisive political issues, including immigration, the Confederate flag, gun control and the National Football League national-anthem protests."

Source:
TO IMPROVE RELATIONS WITH NORTH KOREA
U.S. Cancels Military Exercise With South Korea
4 hours ago
THE LATEST

The United States and South Korea have suspended "another major joint military exercise to give the diplomatic process with North Korea 'every opportunity to continue.'" Exercise Vigilant Ace, which last year "involved 12,000 US troops and some 230 military aircraft from the US and South Korea," was due to take place in December. Trump has canceled other operations in the past, which Gen. Robert Abrams said "had resulted in a 'slight degradation' to the readiness of US and Korean troops," but were a "prudent risk" to improve improve relations with Pyongyang.

Source:
STILL SKIPPING "DAVOS IN THE DESERT"
Mnuchin to Attend Saudi Terror Financing Meeting
6 hours ago
THE LATEST

"Treasury Secretary Steven Mnuchin has decided to take part in an anti-terror finance meeting with Saudi security officials and their Middle Eastern counterparts in Riyadh later this month, opting to attend despite growing global outrage over the suspected murder of a U.S.-based journalist at the hands of Saudi operatives, according to three people familiar with his travel plans. The security gathering next week is separate from a Riyadh financial summit that Mnuchin announced on Thursday he would not attend."

ACCUSED OF HIDING DOCUMENTS ABOUT NASSAR'S ABUSE
Ex-USA Gymnastics CEO Indicted For Tampering With Sexual Assault Evidence
6 hours ago
THE DETAILS

"Steve Penny, the former president and CEO of USA Gymnastics, has been indicted on a felony count of tampering with evidence" in the sexual assault case against disgraced USA gymnastics physician Larry Nassar. Nassar was found guilty in January of sexually abusing dozens of young gymnasts, and was sentenced to 40 to 175 years in prison. Penny, who was arrested on Wednesday in Gatlinburg, Tennessee, "is accused of ordering the removal of documents from the Karolyi Ranch in Texas," where much of Nassar's abuse occurred.

Source:
HE MAY NOT AUTHOR A LARGE, SWEEPING NARRATIVE
Public May Not See Mueller Report
7 hours ago
THE LATEST

Defense attorneys involved in the Mueller probe say the public "shouldn’t expect a comprehensive and presidency-wrecking account of Kremlin meddling and alleged obstruction of justice by Trump — not to mention an explanation of the myriad subplots that have bedeviled lawmakers, journalists and amateur Mueller sleuths. ... Perhaps most unsatisfying: Mueller’s findings may never even see the light of day."

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