Practicing patchless

A temporary patch that delayed cuts in Medicare reimbursement expired on April 1, threatening to take a bite from fees paid to physicians. The Centers for Medicare & Medicaid Services (CMS) saved the day—for you, perhaps, but maybe even more for the Senate.

The patch was last year’s solution by Congress for addressing the sustainable growth rate (SGR) formula, a snippet of legislature that was enacted in the late 1990s to keep Medicare costs in line with the national economy. But the formula is flawed, and efforts to repeal it have been ongoing for a decade or more. Congress has repeatedly made provisions to prevent cuts to fees without revising or repealing the SGR.

Last year offered some hope, followed by disappointment and the patch. A bipartisan group of lawmakers devised a proposal that permanently repealed the SGR and locked in a 0.5 percent increase in physician fees annually for five years. It went down to—and tripped over—the wire. Lawmakers instead authorized a patch through March 31, 2015, to give them time to work out how to pay for the changes.

This year, the House got itself in order in time, voting 392-37 on March 26 to repeal the SGR. The Senate, which presumably also had been working on this issue, chose to delay action and take its spring break. It reconvenes April 13.

Yet the dreaded 21.1 percent slice into physician fees hasn’t seemed to happen. CMS reported it will hold claims temporarily, and process them when the Senate returns from recess and votes on the issue. This no doubt is more appealing than a cut in fees, even brief, but it seems like Congress substituted one makeshift approach for another.

This move did save senators having to face irate physicians, and patients, too. It may appear to be a salvation for doctors, but who is to say the Senate will 1) act quickly and 2) actually repeal the SGR. It is conceivable the repeal could become hostage to some political power play. (Imagine!)

This bureaucratic sleight of hand is not a solution, it is merely a delaying tactic. Practicing patchless could be risky if this drags out. After all, how long can you practice with your Medicare claims put on hold?

Candace Stuart

Editor, Cardiovascular Business