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Doc Fix Not Fixed

McDonald Hopkins LLC - Cleveland Office

March 24, 2014

Previously published on March 21, 2014

Democratic and Republican leaders in both the House and the Senate had negotiated a permanent repeal of the broken Medicare Sustainable Growth Rate Formula (SGR). The current SGR has required Congress to step in with annual "doc fixes" to avoid physicians seeing draconian cuts in Medicare re-imbursement payments.

The deal would eliminate the SGR and replace it with a new formula that would drive physicians to meet quality metrics tied to their payments. The goal is to pay providers for treating a person’s disease or illness instead of focusing on the quantity of the tests or treatments they prescribed.

While agreeing on the policy fix, the two sides could not, however, agree on how to pay for the permanent repeal - something that carries a $138 billion plan. Despite the failure to come to a bipartisan agreement, the House moved forward last Friday - before leaving for recess - with a vote on an SGR repeal that was paid for by a five-year delay of the Affordable Care Act's individual mandate.

While the bill passed the House, with 12 Democrats breaking ranks to vote for it, it is dead on arrival in the Democratic controlled Senate and President Obama has vowed to veto the bill if it arrived on his desk in its current form.

Congress intends to pass another short-term "doc fix" instead of the long-term solution physicians have been seeking for years. Lawmakers must act by March 31 to avert an automatic cut to Medicare physicians' pay.


The views expressed in this document are solely the views of the author and not Martindale-Hubbell. This document is intended for informational purposes only and is not legal advice or a substitute for consultation with a licensed legal professional in a particular case or circumstance.

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