Congress considers permanent solution to Medicare doctor pay

Washington – A nightmare Connecticut doctors fear this time of year may soon be banished by Congress.

It has nothing to do with Halloween, and everything to do with the “sustainable growth rate,” a formula approved by Congress in 1997 that was designed to curtail Medicare spending by cutting physician payments if the program’s costs exceeded a set amount.

The problem is that galloping health costs would have drastically reduced doctors’ Medicare reimbursement under the formula. So pressured by the nation’s doctors, Congress has delayed the cuts every year since 2002, usually at the last minute before they would take effect at the end of December.

If members of Congress fail to agree to another “doc fix” this year, payments to the nation’s physicians would be cut by nearly 25 percent.

But Thursday, top-ranking members of the House Ways and Means Committee and the Senate Finance Committee came up with a bipartisan agreement to put an end to the yearly fight over the sustainable growth rate.

“For years, Medicare payments to doctors have been at risk of getting slashed, limiting seniors’ access to high quality care,” said Senate Finance Committee Chairman Max Baucus, D-Mont. “Enough with the quick fixes.” 

The proposal would freeze payments to doctors at their current levels until 2023 while alternative payment models are tested.

Beginning in 2017, the current system of paying doctors a fee for every Medicare patient they treat would be shifted toward a  “value-based performance” program that would tie payments to the quality of treatment a patient receives. Bonuses would go to physicians who made more same-day appointments for patients with urgent needs, made better use of medical records or proved in other ways they practice good medicine.

The agreement still has to be drafted into bill form, approved by the Ways and Means and Finance committees and considered on the floors of the House and Senate before the end of the year to avoid the pending deep cut to physician fees.

Rep. John Larson, D-1st District, a member of the Ways and Means Committee, said he is open to the proposal.

“It is imperative that we move forward on a permanent solution to replace the flawed SGR [sustainable growth rate] formula,” Larson said. “I look forward to hearing from the medical community in Connecticut on this discussion draft and to working with members of the Ways and Means Committee in the coming weeks on this proposal.”

Rep. Joe Courtney, D-2nd District, who has worked for years for a permanent solution to the problem, said he is pleased.

“Over the last several years, I have advocated for a bipartisan and long-term fix to the SGR formula that ends the year-to-year uncertainty that doctors and patients have experienced for far too long.” Courtney said. “I am glad to hear that a deal is in sight…”

The Connecticut State Medical Society did not have an immediate reaction to the proposal.

But the American Medical Association praised the effort.

It “is an encouraging development and represents a pivotal step toward stabilizing and improving the Medicare program on behalf of America’s seniors and physicians,” said AMA President Ardis D. Hoven.

 

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