Short-term doc fix leaves long-term ques­tion

Modern Healthcare - - EDITORIAL MODERN HEALTHCARE - Rich Daly

With short-term doc-pay fix in place, push is on for long-term so­lu­tion

The high­light for providers of the hard-fought bud­get and tax bat­tles in Congress in the wan­ing days of 2011 was the de­lay of deep cuts to Medi­care physi­cian pay, if only for a mere two months. But the fight over how the govern­ment will pay for a longer-term so­lu­tion will be­gin anew as the ex­pi­ra­tion of the twom­onth patch ap­proaches.

Physi­cian ad­vo­cates pub­licly scolded Congress but were pri­vately re­lieved, sev­eral told Modern Health­care, when a last-minute tax­cut bill in­cluded a two-month post­pone­ment of a sched­uled 27.4% Medi­care pay­ment cut that was sup­posed to oc­cur Jan. 1.

The fi­nal deal, con­gres­sional sources said, was in­tended to give leg­is­la­tors time to find com­pro­mises on how to fund a one- to two-year ex­ten­sion of the cur­rent Medi­care rates. The need for the short-term deal be­came clear as the cal­en­dar ran out on the year and Repub­li­cans and Democrats re­mained far apart on how to pay for a longer ex­ten­sion.

That divi­sion was il­lus­trated by the very dif­fer­ent ap­proach to the Medi­care pay is­sue in­cluded in the ver­sion the House of Rep­re­sen­ta­tives passed sev­eral days be­fore agree­ing to the two-month ap­proach backed by the Se­nate. The House bill would have averted the physi­cian pay cut for two years and pro­vided a 1% pay­ment in­crease to physi­cians in 2012 and 2013. The House bill also in­cluded two-year ex­ten­sions of sev­eral Medi­care pro­vi­sions set to ex­pire (the fi­nal law ex­tended them for two months), such as ex­tend­ing the Qual­i­fied In­di­vid­ual Pro­gram, which pro­vides Medi­care Part B premium sub­si­dies to low-in­come se­niors.

But Repub­li­cans paid for the $38.9 bil­lion two-year physi­cian fix with cuts that drew ob­jec­tions from other providers, such as $17 bil­lion in re­duced pay­ments to hos­pi­tals and an $8 bil­lion cut from the Pa­tient Pro­tec­tion and Af­ford­able Care Act’s pre­ven­tion and pub­lic health fund.

The off­sets led sev­eral hos­pi­tal ad­vo­cacy groups to mobilize mem­bers to pres­sure Congress to re­ject the House-passed ap­proach to pre­vent­ing the physi­cian pay­ment cuts.

For ex­am­ple, the Amer­i­can Pub­lic Health As­so­ci­a­tion launched a let­ter cam­paign and in-per­son Capi­tol Hill vis­its from its mem­bers in mid-de­cem­ber specif­i­cally to op­pose cuts in the pre­ven­tion fund. “Chronic dis­ease spend­ing makes up a sig­nif­i­cant ma­jor­ity of our sky­rock­et­ing health­care costs, and the Pre­ven­tion Fund presents an op­por­tu­nity to rein in our health­care spend­ing by re­duc­ing the rate of many lead­ing chronic dis­eases,” the group said in a Dec. 13 let­ter to mem­bers of Congress. “Di­vert­ing any por­tion of this fund­ing would de­rail cur­rent pub­lic health ac­tiv­i­ties in com­mu­ni­ties and states across the coun­try and would leave Amer­i­can fam­i­lies

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