The day after voting to repeal Obamacare, the House of Representatives demonstrated the much touted–but much ignored by Democrats–political practice of bipartisanship. The House passed a resolution to draft legislation to change one aspect linked to the revolutionary health care overhaul, which most Americans have found so distasteful. Republicans wanted to fix the “doc fix.”
The Republican-controlled House voted 253 to 175 to direct four House committees—Education and Labor, Ways and Means, Energy and Commerce, and Judiciary—to draft replacement legislation to reflect GOP priorities on the seemingly irresolvable problem of reimbursing doctors for treating Medicare patients. Some 14 Democrats joined the Republicans in that vote. Then, lo and behold, they voted 428 to 1 for an amendment to the resolution to fix permanently the so-called “Sustainable Growth Rate (SGR) formula” used to set how much money physicians get from Medicare. Only Rep. John Conyers (D-MI) voted against it.
That Sustainable Growth Rate formula would have set of a 25 percent pay cut in doctors’ reimbursements on January 1 if Congress hadn’t voted last December to delay it for 12 months. The “doc fix” has become as uncertain as rolling a 7 at a Las Vegas dice table. Planned cuts in reimbursements have been systematically overridden by Congress since 2002. It was first put in place in 1997. Since then it has been a financial sword of Damocles hanging over the doctors who treat the most vulnerable patients, the aged. In 2010 alone, Congress passed five temporary delays in the rate cuts.
During the debate over health-care reconstruction, in their attempts to squeeze costs, the Democrats tried to make believe that Medicare reimbursements to doctors were not related to the new law, even though Senate Leader Harry Reid (D-Nev) had used the doc fix in an early draft of the bill to buy support for the bill from the American Medical Association. But the cost proved to be too high. So, the doc fix was left out of the final version of the law.
The Jan. 20 amendment to the House resolution contains no specifics as to what a doc fix would look like.
The Republicans, however, run smack into the problem of paying for a permanent doc fix because they have vowed to cut, and cut, and cut spending. Making the doc fix permanent would cost more than $400 billion over 10 years. Congress could possibly turn to the idea of the co-chairmen of the President’s Commission on Fiscal Responsibility, Alan Simpson and Erskine Bowles. It would freeze Medicare rates through 2013, reduce them by 1 percent in 2014, then come up with a new formula the next year that would reward physicians for the quality, not the quantity, of their service to patients. The Centers for Medicare and Medicaid (CMS) would be assigned to develop a long-range formula.
The Health Affairs blog written by Dr. Jeff Goldsmith, president of Health Futures and associate professor of Public Health Sciences at the University of Virginia, explains that physician cost increases were muted during the first couple of years of the cap on fees. Then the imaging boom [MTIs, PET scans, etc.] exploded, “pushing Medicare physician costs skyward.” Other technologies added to the growing imbalance. An increase in physician “self-referral,” as doctors used referral to diagnostic or therapeutic services they themselves owned was not enough to offset the declining value of Medicare fees. As a result, a huge Medicare debt now bulges in the budget. “To substitute fee increases equal to the Medical Inflation Index (MEI) would cost $439 billion. To do that and hold beneficiaries harmless from resulting increases in their Part B premiums would cost $556 billion,” Goldsmith figures.
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