Frustrating “Doc Fix”
Frustrating “Doc Fix” | Dr. Peter W. Carmel, American Medical Association, American Academy of Family Physicians, Dr. Glen Stream, American Osteopathic Association, American College of Physicians, American College of Surgeons, Dr. Susan L. Turney, Medical Group Management Association, American College of Medical Practice Executives, MGMA-ACMPE, Harold Ingram, PerforMax.

Medical professionals call congressional 10-month delay on SGR cuts “another patch” for “ticking time bomb” of deeper Medicare cuts in 2013

Doctors dodged a bullet on March 1 when Congress deferred steep physician payment cuts under the Medicare program until 2013. Instead of a collective sigh of relief, the medical community cringed. Now instead of a 27.4 percent cut that was scheduled to hit their pocketbooks, doctors are bracing for a pay formula that will slash physician rates by an estimated 32 percent in 2013. Even House Minority Whip Steny Hoyer, a Democrat from Maryland, called the delays “a silly little game.”

In December, medical professionals criticized Congress for implementing a 2-month delay in Medicare payment cuts to physicians and other health professionals under Part B for the remainder of 2012 instead of seeking a longer-term solution. The Congressional Budget Office has projected that freezing Medicare pay rates this year would deepen the scheduled reduction to 32 percent in 2013.

Critics had speculated that Congress would delay the move until after the 2012 presidential election. They called the conference committee’s discussion of spending funds from the Overseas Contingency Operations – money unspent because of decreasing military operations in Iraq and Afghanistan – to cover the $300 billion-plus cost to repeal the SGR (sustained growth rate) altogether a “dog and pony show.” Conference Committee Co-chair Dave Camp, a Republican from Michigan, said he preferred a House bill version that called for a two-year payment fix that was fully offset by cuts elsewhere in the healthcare system.

On Feb. 17, the House voted 293-132 in favor of another delay via H.B. 3630. (Ninety-one Republicans and 41 Democrats voted against the bill). A day later, the Senate approved the measure by a vote of 60-36. (Thirty Republicans opposed the measure.) “That was the only bill,” explained Camp, “that extended these programs through the end” of next year.

“Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice,” said Peter W. Carmel, MD, president of the American Medical Association. Even though “we appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem, we’re deeply disappointed that Congress chose to just do another patch – kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients. Shortly after the coming elections, access to care for seniors and military will again be threatened by an even larger cut, and members of Congress will need to take swift action to end the broken formula.”

Carmel said the “serious missed opportunity” to permanently replace the flawed Medicare physician payment formula was costly. 

 “People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion,” he said.

The American Academy of Family Physicians (AAFP), arguably the largest primary care provider (PCP) group that’s most affected by the move, called the temporary patch a political maneuver that “merely postpones the inevitable.”

“The continued threat of deeper cuts to Medicare physician payment is the tip of the iceberg,” said AAFP President Glen Stream, MD. “Private insurers and TRICARE, which covers members of the military and their families, base their physician payment on the Medicare rate. When Medicare threatens to slash reimbursement, the private sector follows. That reality underlies recent survey data showing that a 25 percent Medicare pay cut would force more than one in 10 family physicians to close their doors. No business can remain viable when forced to work in such an uncertain and shifting revenue environment.”
The day before the House voted on the measure, the AAFP, American Osteopathic Association, American College of Physicians and American College of Surgeons – together, they represent a half million physicians – urged lawmakers to use the overseas military funds to defray the cost of an SGR repeal.

“End the charade,” said Stream. “Give Americans a solution. Repeal the SGR. Replace it with a system that stabilizes Medicare with predictable, sustainable payment that builds on primary medical care and thereby improves outcomes and helps control costs.”

The “doc fix” allows Medicare to maintain current physician reimbursement rates, cuts $5 billion from the prevention and public health fund created by federal health reform law, while also reducing assistance to hospitals when Medicare beneficiaries don’t pay for services, and reducing Medicaid funding to Louisiana, which received a funding boost from the overhaul.

MGMA-ACMPE CEO Susan L. Turney, MD, said the newly merged group of the Medical Group Management Association (MGMA) and the American College of Medical Practice Executives (ACMPE), which provides nearly half of healthcare services delivered in the United States, was “deeply disappointed that Congress has missed a unique opportunity to repeal the SGR once and for all and instead has chosen political expediency over patients.”

“Group practices are telling us that this congressional decision exacerbates an already unhealthy environment that limits their ability to plan for the future and balance their practice’s fiscal health with their desire to continue to serve Medicare beneficiaries,” she said.  

Harold Ingram, CEO of PerforMax Inc. in Jackson, Miss., and immediate past president of MGMA of Mississippi, called the move yet another stopgap measure.

“Please continue to push for a permanent fix to the SGR problem,” he urged.