"Doc Fix" Deadline Nears -- Will Congress Punt Again?

Michael Sheehan

The 23% Medicare pay cuts are scheduled to go into effect Dec. 1, unless politicians act to delay it. The current prognosis from Washington, however, is that the lame duck Congress will punt once again, passing the political hot-potato to the incoming class.

The Republican landslide on Election Day may not be good news for doctors hoping for postponement of the 23% Medicare pay cuts scheduled for Dec. 1. Republican opposition to the increased cost of pushing back the cuts without balancing the extra expense with spending cuts elsewhere helped prevent a longer moratorium on fee rollbacks. The current prognosis from Washington pundits, however, is that the lame duck Congress will punt once again, enacting a short postponement and leaving the issue, including the question of the sustainable growth rate formula (SGR), the formula used to set Medicare fees, to the incoming class.

The American Medical Association has already weighed in, urging lawmakers to push the deadline forward to Jan. 1, 2012, and instead give doctors a 1% increase in payments for next year. The AMA maintains that the postponement will give lawmakers time to iron out a new payment-rate formula to replace the SGR. The 13-year-old SGR has rarely been used, as cuts mandated by the formula have been postponed every year for the past several years.

U.S. Department of Health and Human Services Secretary Kathleen Sebelius also has urged Congress to act quickly on the so-called “doc fix.” She recently called acting on the cuts the “single biggest step” that lawmakers can take to strengthen the Medicare program and said that preventing the cuts is one of the Obama administration’s top priorities.

In the meantime, the co-chairmen of the President’s National Commission on Fiscal Responsibility and Reform have offered solutions that aren’t likely to please any of the groups involved. For starters, their proposal would avoid the massive cuts mandated by the SGR, but would impose smaller cuts from now through 2015. They also propose creating a new formula to replace the SGR by 2015.

In addition, the money-saving recommendations include comprehensive tort reform legislation that would cap awards for noneconomic damages in malpractice cases and would help cut the costs of practicing defensive medicine. The proposals would also require higher out-of-pocket costs for Medicare beneficiaries and would make pharmaceutical companies pay the government rebates on brand-name drugs if they want to be included in the Medicare Part D drug program.