Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Proposed 'Doc Fix' Could See Congressional Vote

Published on Mon Mar 23, 2015

PDF

As most Part B practices know, you’ll face a 21 percent reimbursement cut on April 1 if Congress doesn’t vote to override it. Although most analysts expect you to get a reprieve to the cut, it appears that legislators may finally be poised to fix the Medicare payment formula instead of continuing to offer temporary fixes to the Sustainable Growth Rate (SGR) issue.

At press time, lawmakers were working across party lines to secure passage of legislation that would eliminate the SGR formula for Medicare physician payment once and for all. Congress has passed 17 SGR “patches” since 2002, which has made both legislators and physicians wary about simply moving the problem forward yet again.

Eliminating the SGR would be welcome by most Medicare providers, but the price of saying goodbye to these temporary “doc fixes” may be too steep for some members of Congress.

In the proposal: The current plan in Congress, which could go under a vote soon, would give 0.5 percent annual boosts to Medicare pay for five years, after which practitioners would get bonuses based on quality of care rather than the number of procedures they administer. The cost of the plan would reportedly amount to about $200 billion over the next decade, and some of that cost could be passed on to higher-earning Medicare beneficiaries, to the chagrin of many Congress members.

Medical associations voiced optimism about the potential for SGR elimination. “We remain optimistic that our collective voices will make a difference and that Congress will finally act on eliminating the SGR,” said Robert M. Wah, MD, president of the AMA, in a March 16 statement. “It’s time to end this annual game of kicking the can down the road that is unfair to patients and physicians and wastes taxpayer dollars.”

Stay tuned: House Minority Leader Nancy Pelosi (D-Calif.) told reporters that she was unaware of the voting “timetable” on this issue, so it’s unclear when a vote might take place, but keep an eye on the Insider to see whether a permanent SGR elimination is passed, and if so, how it will impact you.