‘Doc Fix' Passes House, Senate Approval Appears Likely

The so-called "Doc Fix" bill to reform Medicare payments by repealing Medicare's Sustainable Growth Rate (SGR) formula appears poised for passage after receiving strong bipartisan support today in the House of Representatives.

Editor's Note: The Senate left for its Easter/Passover recess Friday without voting on the Doc Fix bill. More information here.

The so-called “Doc Fix” bill to reform Medicare payments by repealing Medicare’s Sustainable Growth Rate (SGR) formula appears poised for passage after receiving strong bipartisan support today in the House of Representatives.

The House voted 392 to 37 in favor of HR 2, which would permanently repeal the SGR. The often-criticized, often-amended formula has been used to calculate Medicare payments since 1997. The bill now heads to the Senate. Passing an “SGR fix” has become an annual Washington ritual, to keep payments reasonable in the face of mounting costs.

Organized medicine supports the new bill. The American Medical Association is urging lawmakers to vote for the bill, as is the American College of Cardiology.

“In voting to repeal the sustainable growth formula and replace it with a stable Medicare payment structure, the House has taken an important step towards solving a problem that has caused uncertainty for more than a decade for Medicare patients and for the clinicians who care for them,” said Kim Allan Williams, Sr., MD, FACC, the president of the American College of Cardiology, in a prepared statement.

The bill would give doctors a 0.5% payment increase for each of the next 5 years as Medicare transitions to a payment system designed to reward physicians based on the quality of care provided, rather than the quantity of procedures performed, as the current payment formula does, according to Kaiser Health News.If the bill does not pass, doctors pay will be cut 21%.

Part of the funding would come from higher Medicare premiums for individuals earning at least $135,000, starting in 2018—an estimated 2%of Medicare beneficiaries.

In an op-ed Wednesday in The Hill, 2 doctor-lawmakers, Rep. Ami Bera, MD (D-CA) and Rep. Larry Bucshon, MD (R-IN), said the time has come for action on a permanent SGR repeal. They noted that the formula has been amended some 17 times in the past decade.

“Under the current formula, cuts are indiscriminate and across the board; high-quality, cost-effective doctors are penalized just as much as those who are inefficient,” Bera and Bucshon wrote. “For more than a decade, the financial uncertainty caused by the SGR has left many doctors no choice but to reduce the number of Medicare patients they see and to delay investments in new equipment and innovative practice.”

They said approximately 1 in 4 Medicare patients has difficulty finding a primary care doctor.

The House package also extends the Children's Health Insurance Program (CHIP) for 2 years. In a

Saturday, Senate Finance Democrats said they were “united by the necessity of extending CHIP funding for another four years.”

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Congress came close to repealing the SGR last year, but the measure ultimately failed. This year, health care advocates are cautiously optimistic. President Obama has expressed support for the law.

"I've got my pen ready to sign a good, bipartisan bill," Obama said, according to Capital New York. In his health care newsletter Thursday, Capital's Dan Goldberg said, “The bill does not have unanimous support but it looks to have enough Democrats in the Senate to push it over [the] finish line.”

Halee Fischer-Wright, MD, MMM, FAAP, the new president and CEO of the Medical Group Management Association, urged the Senate to approve the measure “immediately.”

“Medicare innovation has been hampered far too long by the SGR,” she said, in a press release. “The Senate is one vote away from returning stability to patients and physicians in Medicare.”