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Physician Fees

Short-Term Medicare ‘Doc Fix’ Approved

Cuts are stalled for six months, but critics say temporary patches undermine physician practices

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— Thomas Barwick/Getty Images

President Obama on Friday signed into law the six-month “doc fix” to halt a steep cut in the fees paid to doctors who accept Medicare patients. The House passed the short-term solution on Thursday, even as House Speaker Nancy Pelosi acknowledged it is “ totally inadequate.”

The vote in the House was 417 to 1. Pelosi said earlier that the House had no option but to pass the Senate legislation, as a larger package had been stalled in the Senate. Democrats have tried for months to get a longer, more expensive fix through Congress, but Senate deficit hawks refused to approve such a measure.

“After all is said and done, no one can say this is a great bill,” said Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee. “It’s a disappointment, it’s an embarrassment.” He added that Democrats would spend the next five months looking for a permanent fix to the problem.

The $6.4 billion measure approved last night reverses a 21 percent cut in physician payments that had raised the possibility that some doctors might begin to turn away those covered by Medicare. The measure is retroactive to June 1.

The short-term solution disappointed physicians who wanted a longer delay, and it does little to ease consumer fears that more doctors will stop taking Medicare patients while they remain uncertain whether the pay cuts will again be postponed at the end of the year.

Jen Brull, M.D., a family physician in Plainville, Kan., said the short-term solutions wreak havoc on small businesses like her solo practice.

“What Congress is not understanding is that by doing these tiny hop-stitch patches that they don’t take action on, they leave us on the hook,” Brull said. She’s not dropping Medicare patients—in her small town in rural northwest Kansas they are her neighbors and friends—but the financial uncertainty of Medicare reimbursements can put small practices in jeopardy.

“The short-term Band-Aid passed Thursday gives little reassurance to the 46 million Americans in Medicare who need reliable access to their doctors,” said AARP Executive Vice President Nancy LeaMond. “The time for Congress to find a long-term physician payment solution is far past due. With the drastic 21 percent cut in effect for nearly a month, seniors in Medicare are already facing more difficulty finding a doctor.”

This “doc fix” scenario, as it’s called in Washington, has occurred every year for nearly a decade. Under a law passed in 1997, Medicare rates for physicians and other providers are calculated under a complex formula that was designed to curb the growth of Medicare costs, but later resulted in cuts so unpopular that Congress has annually postponed them. The legal requirement remains, however, swelling the cuts cumulatively to reach 21 percent this year.

“These short-term fixes are really undermining physicians confidence that this is going to be taken care of,” said Lori Heim, M.D., president of American Academy of Family Physicians.

Heim and other doctors say that even with Congress enacting this latest fix, it will not necessarily prevent doctors from limiting the number of Medicare patients they treat or opting out of the program altogether unless the current payment formula is repealed. Obama has also called for a permanent fix. Doctors “shouldn’t have this guillotine hanging over their heads every year,” he told a town hall meeting of seniors recently.

“Congress is playing Russian roulette with seniors’ health care,” American Medical Association President Cecil B. Wilson, M.D., said earlier in the battle. “Already the instability caused by repeated short-term delays is taking its toll.”

The situation affects not only physicians but also millions of patients enrolled in Medicare and TRICARE, the health program for military families that ties its payment rates to those of Medicare. A series of temporary solutions “creates a dangerous atmosphere for seniors and their doctors,” said AARP’s LeaMond. “Finding a physician is already a challenge for older Americans.”

Barbara Basler is an executive editor at the AARP Bulletin.

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