Groundhog Day for Medicare physician payment cuts

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There's a game called the "temporary doc fix.” Congress plays it every year and I'm beginning to tire of it.

Our elected officials not only are wasting time and money over it, but acting cowardly as well (which really bugs me). Here's why: Congress knows that it has to find some way to pay doctors who treat Medicare patients at a decent rate. Yet each year, because of a reimbursement formula that was put in place under a 1997 federal statute, Medicare doctors face steep cuts to their funding. And every year Congress has to step in and overturn them. 

Even more frustrating is that stalling over the physician pay solution does not just affect doctors. It also affects the calculation of allowances for nursing home Part B therapy. So the wait ends up tying up a lot of important funding for providers. 

The reason that Congress won't find a permanent solution is it doesn't want to face the reality of how much repealing the formula would cost—an increase of more than $200 billion over 10 years. (Hey, wait a minute. Why did we pass healthcare reform again? Geez.)

So each year Congress keeps putting off permanently “fixing” the problem, and each year doctors face a potentially steep drop in funding. (Of course, it never happens.)

This year was particularly annoying with a looming 21% cut scheduled to take effect in March. As Congress continues to waver on passing a bill, the Centers for Medicare & Medicaid Services has had to step in repeatedly to delay it.

Now, Groundhog Day for the physician pay cut is upon us. The cuts are again scheduled to take effect Thursday. Congress once again is planning pass a temporary fix to the problem. It likely will, but should it even have to?

Tiresome therapy caps

Of course, talking about the “doc fix” touches another sore spot: Medicare Part B therapy caps.

The problems are essentially the same. Congress knows it has to get rid of the caps, but it doesn't. Each year, nursing homes face the caps, and it takes legislation extending an “exceptions process” for the caps to offset them. The exceptions process covers most nursing home residents.

This year was particularly trying, as the resolution was tied up in the healthcare reform law.

While lawmakers were wrangling over healthcare reform, residents were hitting the caps and nursing homes were wringing their hands in desperation. Is that fair?  

As in the case of the Medicare physician pay cut, lawmakers need to find a solution, and stop putting off a permanent fix for another year.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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