A provision in the bill specifically addresses Medicare's sustainable growth-rate, or SGR, formula, which is based on the health of the economy and has been threatening cuts to doctors since 2003. The measure earmarks $82 billion to help fund a revamp of the SGR and does so in such a way that it doesn't require offsetting cuts in other areas.
What it doesn't do, however, is tackle how to fully pay for what has become a $200 billion problem, or try to repeal or replace the SGR.
“We still don't have an update for this year, and if nothing else happens, physicians still face a 21% reduction on March 1,” said Kevin Burke, director of government relations at the American Academy of Family Physicians.
Burke offered that Congress might be looking to attach a more substantial type of fix to a bill that would extend unemployment insurance.
“I don't know if this would originate in the House or the Senate, but it would specify a payment update for a set number of years. I understand the amount of the update and the length of the provision are still under discussion,” he said, adding, “This is not likely to get resolved until the final week of February.”
In the meantime, Senate Finance Committee Chairman Max Baucus (D-Mont.) has indicated a short-term freeze on physician payments might be attached to the jobs bill the Senate plans to bring to the floor this week.
Separately last month the Senate in approving a bill to raise the national debt ceiling inserted language to provide a “rainy day” fund of sorts to help fund a revamp of the SGR.
Like the House bill, the Senate version frees up $82 billion to partially cover the cost over five years and does so in such a way that it doesn't require offsetting cuts in other areas—as is often necessary—but doesn't tackle the thorny issue of how to pay for the rest or structure such a change.
This temporary solution has already drawn criticism from physician organizations, which claim that, once again, Congress hasn't gone far enough to address the problem. “They didn't come up with enough money to actually fix it,” or provide any blueprint on a long-term solution, says Lori Heim, M.D., president of the American Academy of Family Physicians.
Congress has stepped in each time to enact a temporary fix so that doctors won't experience additional reductions to their Medicare payments, but the industry, facing yet another 21.2% cut to their payments in March, wants a permanent solution.
Some physician lobbyists believe the Senate, in freeing up the money, is trying to advance that goal. It's not a full-blown fix, yet the language in the debt-ceiling bill “is heading in the right direction,” says Gordon Wheeler, associate executive director for public affairs with the American College of Emergency Physicians. “To the extent they're pursuing an incremental approach, it's to produce a positive result,” he says.
But a long-term SGR fix is going to require more than an $82 billion startup fund. The money earmarked for an SGR fix in the Senate debt-ceiling bill would be the equivalent of freezing physician payment rates for the next five years, says Robert Doherty, senior vice president of governmental affairs and public policy with the American College of Physicians.
“That is not nearly enough to pay for a complete repeal, which would cost more like $210 billion to $230 billion,” Doherty says.
Joseph Stubbs, M.D., an internist in Albany, Ga., and ACP president, views this latest Senate solution as just another patch. Staving off the cuts over the years has resulted in this $200 billion-plus debt, Stubbs says. Even if Congress provides some additional money to fix the SGR, this debt will continue to accumulate until lawmakers change the formula, he adds.
Even if the Senate and House stop-gap measures become law, Congress still faces the additional chore of approving legislation to address the actual problem, Doherty says. While the House managed to approve a bill late last year that fixes the problem, attempts in the Senate have failed.
What physicians don't want is another temporary patch, Doherty says. The ACP, American Medical Association and other groups “will continue to do everything possible to push for full repeal,” he says. The AMA declined to comment for this story.
Wheeler wouldn't speculate on how Congress might proceed. “It's the toughest game in town” to figure out what the lawmakers will do on this chronic payment problem, he says. “The important thing is to get the SGR fixed.”
Just in case that doesn't happen, HHS' fiscal 2011 budget request includes an adjustment adding $371 billion to Medicare payments to physicians over the next 10 years.
The president's budget assumes that Congress will once again intervene, “so our budget is based on a zero (percent) growth rate for physicians” over 10 years, and not the 21.2% cut for Medicare services scheduled for the end of the month, HHS Secretary Kathleen Sebelius said during a news briefing to release her department's $911 billion budget proposal.
No specific offsets were included in the budget request to pay for this specific adjustment, however, meaning the $371 billion “would be rolled into the budget baseline and add to deficit spending,” explained Alexander Vachon, a Washington-based healthcare consultant.
President Barack Obama's fiscal 2010 budget blueprint included a similar adjustment of $311 billion to account for Medicare physician payment updates at zero percent vs. the scheduled negative updates, over 10 years.
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