The potential trouble comes when lawmakers look for money to plug the estimated $116 billion hole over 10 years that would cover the cost of a permanent fix. This is a huge threat to hospitals in general and rural hospitals in particular because, well, it's happened before.
"Whether it's for the debt ceiling or a temporary doc fix or a permanent SGR fix it all has to be paid for and unfortunately the scenario that played out in the past is to rob Peter to pay Paul," says Maggie Elehwany, vice president of government affairs at the National Rural Health Association.
Do you recall how they paid for that latest temporary SGR bill that expires on March 31?
"They extended sequestration for rural providers for two years," Elehwany says. "A lot of people thought that it was solved when we had that last budget deal and Congress made a bunch of speeches about how we fixed the problems with sequestration. They did curb sequestration for discretionary spending only. For mandatory spending, Medicare, those sequestration cuts are still in effect. Not only are they still in effect, they were expanded for another two years. In 11 years from now we will be done with it, but that is a 2% cut across the board for the next 11 years and no provider can withstand that."
Fixing the SGR will help rural physicians, but not if it comes at the expense of the rural hospitals that provide safety net access for about 60 million Americans.