Physicians are once again waiting for Congress to avert a 27% Medicare physician fee cut scheduled to take effect on March 1.
The pay cut was originally scheduled to begin Jan. 1, but after much back-and-forth in Congress, the House and Senate passed the Temporary Payroll Tax Cut Continuation Act of 2011 on Dec. 23, which included an extension of 2011 Medicare physician-payment rates through the end of February. President Obama quickly signed the bill into law.
Lawmakers also agreed to appoint a 20-member House-Senate conference committee to work on a longer-term plan to address the Medicare physician pay issue, along with a full-year extension of the Social Security payroll tax holiday and federally funded unemployment insurance benefits.
The agreement followed several days of brinksmanship by leaders in the House and Senate. It started on Dec. 13, when the House passed a bill that would have replaced the 27% Medicare fee cut with a 1% pay raise for physicians for 2 years. Despite bipartisan support for the so-called doc fix, other controversial provisions in the bill kept it from gaining traction in the Senate. A few days later, the Senate approved their own version of the bill, which extended the payroll tax holiday and unemployment benefits for 2 months and postponed any Medicare pay cuts until the end of February.
The House initially rejected the idea of a short-term fix, and even passed a resolution to formally disagree with the legislation passed by the Senate. But intense public criticism led House leaders to agree to the short-term plan and use the first 2 months of this year to negotiate a compromise.
Physicians remain furious with Congress for its inability to find a long-term solution in 2011.
“There's a tremendous degree of frustration out there,” said Robert Doherty, senior vice president for government affairs and public policy at the American College of Physicians. “If Congress is expecting physicians to applaud them for agreeing to a 2-month extension, they're going to find a lot of silence from the physician community.”
Dr. Jeffrey Cain, a Denver family physician and president-elect of the American Academy of Family Physicians, said that the last-minute legislation was no way to conduct the nation's business, and that it failed to meet the needs of physicians and patients. “Every time we kick the can down the road and we fail to address the issue, we put family medicine and – more importantly – the health of millions of Americans at risk,” Dr. Cain said.
Frustration is especially high because members of Congress had signaled early in 2011 that they were interested in crafting a long-term solution to replace the Sustainable Growth Rate formula, the statutory formula that ties spending on physicians' services to the gross domestic product. In March 2011, leaders in the House Energy and Commerce Committee wrote to several physicians' groups asking for proposals on how to reform the physician payment system and move to a new system that “reduces spending, pays providers fairly, and pays for services according to their value to the beneficiary.”
The letter emphasized the need to act quickly in developing a long-term solution, or risk the “unwanted choice of extending a fundamentally broken payment system or jeopardizing access to care” for Medicare beneficiaries. “We cannot let either happen,” the lawmakers wrote.
It's too soon to tell what Congress will do next, but both Mr. Doherty and Dr. Cain agreed that a long-term solution that would replace the SGR is unlikely right now. Instead, AAFP officials are pushing for a 2- to 3-year patch that would give lawmakers time to enact a permanent SGR fix.
In a worse-case scenario, physicians could be facing a situation similar to what happened in 2010, when Congress passed a series of temporary patches during the first half of the year, Mr. Doherty said. That situation could become a reality if lawmakers once again are deadlocked on the larger legislative package. “To a great extent, we're once again going to be held hostage to negotiations over a broader package on issues that really have nothing to do with the SGR.”
Every time we kick the can down the road, we put the health of millions of Americans at risk.
Source DR. CAIN