generally skeptical about the prospects for a permanent “doc fix” —
an end to the Medicare physician reimbusement formula that calls
for doctor payment cuts every year, and that that Congress always
overrides as a result. Members of Congress in both parties have
long said that they want to ditch the formula, known as the
sustainable growth rate (SGR), entirely. But the official estimated
cost of doing so has always made that difficult. This week, however, a permanent fix got a lot easier. Because
according to the Congressional Budget Office, it got a lot cheaper.
Here’s National Journal with the details:
In its budget outlook released on Tuesday, the CBO slashed
the projected cost of a long-term “doc fix” by nearly
half. That change means that if Congress wants to reverse the
flawed and universally disliked 1997 Medicare payment formula known
as the “sustainable growth rate,” it won’t have to come up with
nearly as much money as previously expected.
The sustainable growth rate, or SGR, has been a perennial
problem because it would pay doctors much less than they currently
get for treating Medicare patients. Every year, Congress reverses
the formula to keep payments from dropping, but only for a short
period of time. In January, the latest one-year fix passed
of the fiscal-cliff package.
This week, two proposals for reversing the SGR forever began
circulating on Capitol Hill. On Wednesday, Reps. Allyson Schwartz,
D-Pa., and Joe Heck, R-Nev., introduced
a bill that would replace the formula with a temporary
system of physician pay raises, to be followed by new payment
methods that would reward more-efficient care.
I’m not sure I’d go so far as to say I think that a permanent
doc fix is now likely. But unlike before, I do think it has a
chance. For those who prefer transparent budgeting, that’s a good thing:
Congress was never likely to let the cuts go through, which means
that the money was already going to be spent. A permanent fix would
mean that future budget projections no longer include the
implausible assumption that Congress will actually allow the cuts.
It would also relieve doctors of the nagging worry that maybe, just
maybe, Congress won’t pass an ovStill, I remain skeptical that fixing the doc fix really
fixes much of anything. For one, the CBO generated its newly lower
price tag by assuming that we won’t spend as much on Medicare in
future years as previously thought, which is far from guaranteed.
For another, Congress would replace the SGR with some other payment
mechanism. And while it probably wouldn’t create budget
complications of the same magnitude, it would probably come with
flaws and distortionary effects of its own.
See more here: