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Updates Regarding “Doc Fix”

Posted in Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

On December 18, the U.S. Senate passed a budget agreement that delays for three months significant cuts to physicians’ Medicare payments that were scheduled to take effect on January 1, 2014 pursuant to Medicare’s Sustainable Growth Rate (SGR) formula. The U.S. House of Representatives already approved the budget bill on December 12.

In addition to the three-month delay measure, Congress continues to work toward a permanent solution to the annual “doc fix” problem, in which legislators must override impending statutory payment cuts to physicians in a manner similar to the current three-month delay.  This year, application of the SGR formula would have resulted in a 20.1% reduction in Medicare payments to physicians beginning January 1.

Also on December 12, the House Ways and Means Committee and Senate Finance Committee each passed their versions of a bill to permanently repeal the SGR, more fully discussed here, which would eliminate the need for the annual “doc fix.”  Another SGR repeal bill proposed by the House Energy and Commerce Committee in July appears not to have moved forward.

These actions toward repealing the SGR come after the Congressional Budget Office on December 6 lowered the estimated cost of permanently repealing the SGR to $116.5 billion, a sharp drop from the $139 billion predicted in February 2013 and the $271 billion predicted in August 2012.

Legislators including Rep. Mike Burgess, M.D. (R-TX), vice chair of the House Energy and Commerce Health Subcommittee, have stated that the reduced cost of repealing the SGR makes a repeal more feasible.  In a statement, Rep. Burgess said that he was “certain” that the new estimate would “accelerate the pace in passing the bill.”

There has been strong, bipartisan support for the legislation, with the House Ways and Means Committee passing its version of the bill by 39–0 and the Senate Finance Committee passing its version of the bill almost unanimously.

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