Fears are growing that another two-month temporary patch for Medicare physician pay rates is increasingly possible as congressional negotiations on a long-term solution to the problem appeared deadlocked.
Hope fades for long-term solution from Congress
A bipartisan congressional conference committee aims to avert an automatic 27.4% cut by Medicare’s sustainable growth-rate formula for physicians on March 1 when a two-month freeze at last year’s rates expires.
The two parties have locked into opposing approaches, according to congressional sources, with Republicans generally favoring a two-year extension of the current rates and Democrats pushing for elimination of the payment formula and its scheduled cuts.
But the primary obstacle to any movement on the issue, members of Congress and other sources said, is the stark differences in ways proposed to pay for either approach. Democrats primarily want to use a one-time budget offset of “savings” stemming from the end of the Iraq War, while Republicans continue to push budget cuts, including at least $44.6 billion in 10-year healthcare cuts.
“I think it needs to pass the straight-face test,” House Speaker John Boehner (R-Ohio) said in a news conference last week about proposed funding alternatives. “The fact is, we are going to spend less in our war efforts in Afghanistan and Iraq, and to use those savings to propel more spending doesn’t seem to make a great deal of sense to me.”
The continuing split over funding alternatives has left some provider advocates concerned that another two-month extension of the current patch is increasingly possible as its Feb. 29 expiration date draws closer.
Anders Gilberg, senior vice president of government affairs at the MGMA (formerly known as the Medical Group Management Association), said Congress could miss a historic opportunity to resolve the issue if it uses another short-term patch.
“Given the unique one-time opportunity to repeal the SGR using” war savings, Gilberg said, the “MGMA will be deeply disappointed in any short-term patch, be it two months or two years. All a patch does is increase the size of the next cut and the amount needed for repeal. In a couple years the cut will be 40% and future dollars needed for repeal will be nearing $500 billion.”
Rep. Tom Price (R-Ga.), a physician who is a member of the committee, told Modern Healthcare that he opposes a two-month extension, just as he opposed the two-month freeze that is about to expire. “We believe—I believe—two years is the minimum” needed extension of current rates, he said.
Conferees are communicating regularly about the SGR beyond the public meetings they’ve held, members of Congress said in interviews. The public meetings have largely consisted of presentations and sparring over the partisan funding proposals.
Other members of Congress were less optimistic. “Time is so short they will probably end up with another short-term extension,” Rep. Phil Gingrey (R-Ga.), a physician and co-chairman of the House GOP Doctors Caucus, said. “It would be great if we could get to a year. I’ve always been in favor of separating the doc issue” from the larger package that includes income tax and unemployment insurance provisions.
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