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“Whoop-De-Do!” To The Medicare Physician Pay Cut Problem

After months of dithering, delaying, denying, and defaulting on a decision, Congress ended up…doing as little as possible to address the Medicare physician pay cut problem.

Thursday night the House of Representatives acceded to the Senate’s bill to provide physicians with a 2.2 percent update retroactive to June 1. This respite, though, lasts only through the end of November, when physicians and patients will again face another double-digit cut. And if the past is prologue, a lame-duck Congress then will wait until the very last minute to enact another short-term patch, or worse yet, allow the cut to go into effect on December 1 and then pass some kind of retroactive adjustment.

You know that the situation has gotten ridiculously bad when the President says this about the bill he just signed into law:

“Kicking these cuts down the road just isn’t an adequate solution.”

And when Speaker Pelosi (D-CA) calls it “inadequate” and a “great disappointment” and the best that any had to say about it was this from SFC ranking member Charles Grassley (R-IA):

“This action was critically needed so there’s no disruption in services for anyone.”

But it’s too late.

As I told Katherine Hopson, who writes for the Wall Street Journal blog, “The damage has [already] been done, resulting in a growing lack of confidence in the [government’s] ability to deliver on promises to Medicare patients.”

Yeah, I am fed up with the situation, just as I am sure most doctors are. What is especially galling this time around is that Congress had multiple opportunities over the past year-and-a-half to advance a permanent solution, but ended up just kicking the can.

The Senate could have passed an ACP-supported bill, approved by the House of Representatives in November, which would have completely repealed the SGR and replaced it with a better update framework to allow higher updates for all services and an additional bump for evaluation and management and preventive service visits. It did not.

The Senate could have passed an amendment, offered last year by Senator Debbie Stabenow (D-MI), to eliminate all of the accumulated SGR cuts. It did not.

Just a few weeks ago, the House and Senate leadership appeared to have settled on a plan, developed in consultation with ACP, to provide five years of positive and stable updates and to begin to move to a better payment update framework, based on the bill passed by the House in November. Lacking the votes they needed, they scaled it back to three-and-a-half years, still with a higher bump for primary care and preventive services. This too, was dropped because they didn’t have the votes. The House then passed a 19-month reprieve and the Senate a six-month reprieve (neither of which moved policy to a better payment framework).

Then, for four days this week, the chambers remained at an impasse, until the House acceded last night to the Senate’s six-month patch.


What can be done now? Well, physicians need to hold their elected representative and Senators accountable when Congress returns to their states and districts looking for votes over the Independence Day holiday recess. Tell them how Medicare’s unreliability and instability is affecting you and your patients. Get them to commit to doing whatever is needed to enact a long-term solution that Democrats and Republicans alike will support. Don’t let them get away with blaming someone else.

As ACP President Fred Ralston said on Monday, “Physicians and patients don’t want to hear that it is the Democrats’ fault, or the Republicans’, or the President’s, or the Senate’s, or the House’s. They don’t want to hear politicians claim that they are for repealing the SGR, as they withhold their vote from any practical plan to achieve repeal . . . They want to hear that members of Congress, on a bicameral and bipartisan basis, have agreed on a long‐term solution to replace the unworkable SGR.”

Get them to commit to doing that, and maybe we won’t be sticking seniors with another turkey of a bill come November.

Today’s question: How will you be holding your own member of Congress accountable for the Medicare SGR debacle?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

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