You knew it was too good to be true. The so-called “Doc-Fix” compromise in Congress has collapsed, almost guaranteeing that healthcare providers will once again be required to endure more cuts or paybacks to avoid Medicare reimbursement cuts to physicians.

Last month leaders in Congress announced a bi-partisan solution to permanently end the sustainable growth rate (SGR) that for the past decade has threatened to dramatically cut Medicare payments to physicians. Last week before breaking, House Republicans passed its version of the bill, but with a provision that will never be signed by the president and, in effect, killing the compromise for now.

On April 1, the nation’s physicians under the SGR formula are scheduled to have Medicare reimbursements cut by 24 percent. House and Senate leadership reached a compromise last month that would replace the SGR with modest increases, but, as we reported last month, legislators had not figured out how the nation would pay for it.

The House bill, however, specified that the so-called “Doc-Fix” would be paid for by postponing the requirement under the Affordable Care Act that individuals must purchase health insurance until 2020. The savings, according to House Republicans, would come from the subsidies that the federal government would no longer have to pay.

When Congress resumes next week, it will have one week to come up with another temporary solution to the SGR cuts. In the past Congress has traditionally funded the temporary solution on the backs of healthcare providers. Last year, for example, some $10 billion was found by chasing overpayments to hospitals that resulted from migration to MS-DRGs, and another half billion dollars by extending the statute of limitations for recovering Medicare overpayments to five years (currently three years). Also, reimbursement cuts to Medicaid Disproportionate Share Hospitals (DSH) were extended an additional year.


Congressional Leadership Reaches Accord to End Doc-Fix

Once Again Congress Cuts Hospital Funding to Postpone ‘Doc-Fix’

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