The Doc Fix: Victim of a Congressional Train Wreck

by Sydney Abbot, JD, Policy Coordinator, ACCC

UPDATE. Just before Christmas, Congressional leaders agreed to vote on, and subsequently pass a two-month sustainable growth rate (SGR) fix, along with the two-month extension of the payroll tax credit. The vote will extend the current conversion factor through the end of February 2012.

Here’s what happened leading up to the short-term fix:

In the hope of passing a “doc fix” more quickly, Congress decoupled the sustainable growth rate (SGR) temporary fix from the larger tax extender bill. Unfortunately, that was not enough for the two chambers to agree on a physician payment patch. House Republicans rejected the Senate’s two-month fix, scuttling any hope of reaching agreement by the end of the year as most Congressional members returned home to their districts this week for the holidays.

Congressional failure to agree on a “doc fix” by the end of the year could have created an enormous problem for physicians. Medicare physician reimbursement was scheduled to be slashed by 27 percent starting January 1, 2012.

Shortly after rejection of the Senate plan, House Speaker John Boehner (R-OH) called for a bi-partisan conference committee to be formed with the Senate to reach agreement on the SGR. House and Senate Democratic leaders rejected this idea, even as Boehner went ahead with appointing House Republican conferees. With physicians—and ultimately patients—facing such extreme cuts, Congress stood divided. At the last minute, Republican leadership back-tracked and agreed to a two-month extension.

The Centers for Medicare and Medicaid Services (CMS), having experienced brinksmanship over the SGR in the past, had decided to hold physician claims for 2012 services for the first 10 business days of January (ending January 17) to give Congress a little more time to pass an SGR fix. Inlight of the last-minute two-month temporary fix, this may not be necessary.

ACCC’s distaste for this Congressional inaction is shared by many other provider groups. The American Medical Association (AMA) said it well, calling it “shameful” that “Congress has again failed to fulfill its responsibilities.” In the end, I had hoped that Congress would get its act together and come to agreement at the eleventh hour–which legislators did–giving providers unnecessary gray hairs.

ACCC will be avidly watching for a longer term agreement, and we’ll be sure to keep members updated on this critical issue.