Doc Payment Fix Down to the Wire Again

Janice Simmons, June 11, 2010

The Senate left for the weekend yesterday—leaving behind the jobs bill (HR 4213) that includes the "doc fix" amendment introduced earlier in the week to postpone a 21% cut in Medicare and TRICARE for the next 19 months. But when they return on Monday, senators may take under consideration another amendment that calls for a longer period to postpone payment cuts.

Sen. Debbie Stabenow (D-MI) is reportedly considering an amendment that would stop the 21% Medicare cut with a formula that reflects increases in physician practice costs, while providing somewhat more stability in payments through 2013. Stabenow was author of a bill introduced last fall (S. 1776) to overturn the 21% cut and sunset the use of the sustainable growth rate (SGR) formula; that bill was defeated 47-53.

The American College of Physicians said it supports this possible amendment "as a positive step forward to a permanent solution." The amendment could create payment updates that help reflect increases in physician practice costs through 2011.

The amendment provisions, which are based on legislation (HR 3961) passed by the House in November, "recognizes the importance of ensuring that spending on all physician services be allowed to grow at a higher rate of growth than the unrealistic limits set by the SGR," said ACP President J. Fred Ralston, MD, in a letter to the Senate.

The current amendment in the jobs bill uses the same language passed by the House two weeks ago: physicians would see an increase in payment rates of 2.2% for the remainder of 2010 and a 1% increase in 2011. Rates would return to present law after 2011.

At the current time, the 21% cut is in effect (since June 1) for physician payments. However, the Centers for Medicare and Medicaid Services has told its contractors to hold claims for Medicare reimbursement for 10 business days "to avoid disruption in the delivery of healthcare services." That deadline, however, ends on Tuesday unless Congress approves legislation that addresses the 21% cut.

Janice Simmons Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at
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