Lawmakers map path to 5-year doc fix

House and Senate negotiators on Thursday drafted a pathway for a five-year fix to the Medicare physician payment formula that would give doctors a 1.2% raise for the balance of 2010 with the promise of more to come.

Under the revised provision, part of a broad package of tax extenders and continuations to several safety net health programs, physicians would see a 1% increase in 2011. One year later, the sustainable growth-rate provisions originally set out in the House-passed health reform bill would kick in, according to two healthcare lobbyists with knowledge of the deal.

Originally, joint negotiations between members of the House Ways and Means Committee and the Senate Finance Committee focused on legislation passed by both chambers that would have frozen Medicare payments until the end of the year in an effort to hold off a scheduled 21% pay cut.

But under the plan currently under negotiations, lawmakers are eyeing a longer-term fix that would prevent future cuts from kicking in.

Though negotiations are fluid and could change, the physician fix blueprint would essentially created two “buckets” of physician services: one that includes defined preventive, evaluation and management visits and primary care, and another for all other physician services.

The payment equation is similar to the current SGR structure and would be based the growth rate of the overall economy.

For the first bucket, an inflationary update would be based on GDP plus 2%. For the second bucket, the update would be based on GDP plus 1%.

The House could vote on the package as early as Wednesday, with the Senate voting shortly after.