CMS actuary throws cold water on 'doc fix' bill projections

Senate closes in on Medicaid funding, physician pay vote
Senate closes in on Medicaid funding, physician pay vote

Long-term care leaders who have widely endorsed a House proposal to permanently “fix” the Sustainable Growth Rate formula, might be suffering buyer's remorse after learning Friday that the bill might not provide the lasting relief it promises.

The reason? A report from the Office of the Actuary of the Centers for Medicare & Medicaid Services that concludes the new payment system approved by the House on March 26 would actually result in lower Medicare payments to doctors over the coming decade, when appropriate funding would run out.

“Additional updates totaling $500 million per year and a 5 percent annual bonus are scheduled to expire in 2025, resulting in a payment reduction for most physicians,” Chief Actuary Paul Spitalnic wrote in the April 9 report.

The report added that the risks to physician Medicare rates are “ultimately greater” than the “near term” impacts of the much-hated “sustainable growth rate” formula, or “doc fixes,” it has applied for the past 17 consecutive years. LTC providers have experienced heightened anxiety every time “doc fix” discussions have taken place, worried that parts of their funding would be taken away to pay for it.

If the Senate does not act and approve the House measure, or an 18th consecutive “fix” isn't tendered by Wednesday, the 21% doc rate cuts — which technically went into effect April 1 — will start to actually come out of physicians' payments.

Late last month, the House of Representatives repealed the Medicare Sustainable Growth Rate, earning loud approval from the American Health Care Association and National Center for Assisted Living, which praised the move as a way to “bring much-needed reforms to Medicare concerning therapy reviews as well as long-term stability to the profession.”

Some Senators have complained that there are not enough spending offsets to pay for the bill, while others have expressed a desire to extend the CHIP program four years instead of two. Senate leaders have said they expect to consider only minimal amendments or add-ons when discussion on the bill takes place Monday or Tuesday.