Healthcare cost concept: stethoscope and dollars background
27th Jan

There’s only one outstanding issue left to resolve before Congress can pass a permanent “doc fix,”  how to cover the roughly $140 billion price tag.  

Last year, Congress kicked the can down the road again and failed to permanently do away with Medicare’s widely loathed sustainable growth-rate formula (more fondly known as the “doc-fix”), resulting in a 17th consecutive patch that expires at the end of March. If Congress doesn’t take action, doctors will face a 21.2% cut in payments for treating Medicare patients, an outcome that’s viewed as untenable by both Democrats and Republicans.

The perennial issue was back on the agenda Wednesday on Capitol Hill. Legislators from both parties expressed support for finally coming up with a permanent solution to the financing problem during a hearing before the House Energy and Commerce Committee’s Subcommittee on Health. Lines are being drawn over how to pay for it.  A few possible ways of generating revenue from within the Medicare program were debated, including raising the eligibility age for coverage and increasing costs for wealthier beneficiaries. Another idea that remains under discussion, is combining Medicare Part A, which pays for hospital care and is supported by the payroll tax, and Part B, which covers physician services and comes out of general taxes.

Democrats balked at funding a permanent fix through cuts to other parts of the Medicare program, arguing that it would weaken the safety net for poor seniors. They suggested instead that all revenue sources should be on the table.  Republicans countered that wealthier beneficiaries, particularly those with incomes above $1 million, can easily afford to pay more for coverage.

The debate over the doc fix will continue with another hearing before the same committee.  Also, expiring at the end of March 2015 looms the therapy caps exception process, which is embedded within the SGR.  So please be proactive and reach out to your Congress men and women to make your voice heard for a permanent fix for both the physician rates and therapy caps.

Sheila Capitosti

VP Clinical and Compliance Services


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