With budget out of the way, Congress eyes Medicare fix

Finance Committee Chairman Sen. Ron Wyden (D-OR)
Finance Committee Chairman Sen. Ron Wyden (D-OR)

Now that President Obama has put his signature on a $1.1 trillion spending package, long-term care providers can focus on another looming spending challenge: the so-called “doc fix.”

There are many providers in the post-acute sector who fear their Medicare payments will be trimmed in order to temporarily or permanently fix this perennial issue.

Congress has voted for a “doc fix” at least once a year since 2003, when a spending formula called the sustainable growth rate (SGR) was scheduled to begin cutting physician reimbursement rates to control Medicare spending.

Lawmakers have used “patches” to avert the physician payment cuts 17 times, largely in response to pressure from the physician lobby, as well as fears that doctors would flee the program should the funding reductions actually be carried out.

The cost of continuous patching for 10 years — from 2014 to 2024 — runs about $16 billion, according to the Congressional Budget Office.

Critics allege that temporary fixes have bred corruption and legislative chicanery by creating frequent crises. They add that while these manufactured crises provide a gold mine for lobbyists and political fundraisers, they distract from much-needed Medicare reforms. A growing chorus wants a permanent solution, but it remains unclear whether such a move would eviscerate other providers' payments.