The Doc Fix Is In

Happy New Year! I am happy to be guest blogging at PrawfsBlawg this month, so this is cross posted at: http://prawfsblawg.blogs.com/prawfsblawg/2013/01/the-doc-fix-is-in.html

Roll Call is reporting — citing anonymous Congressional aides —
that a one year Doc Fix is included in the fiscal cliff resolution
package.  This, of course, is unconfirmable.  But I would be astonished
were it not true. Kicking the can down the road on Medicare's
sustainable growth rate formula (SGR) is what we are good at.  Deciding
whether we can ever have a coherent public conversation about Medicare
physician reimbursement rates and the systematic undervaluation of
primary care services, not so much.

The SGR's origins in the Balanced Budget Act of 1997, as part of an
attempt to link Medicare physician reimbursement to the general growth
rate of the economy, are almost lost to history.  Some of this is
because, as early as 2001, the Medicare Payment Advisory Committee
(MedPac)  was calling for its repeal.  This first call for repeal, as
with all subsequent ones, has gone unheeded.  In 2002, the SGR formula
triggered a 4.8% reduction in Medicare reimbursement for physician
services.  Physicians were displeased. And it is physician displeasure
combined with Congressional inability to confront that displeasure that
has kept us at an impasse ever since.  It is not for nought, though
perhaps  an overly cynical insight, that the SGR is sometimes described
as a Congressional fundraising vehicle. So long as Medicare physician
reimbursement hangs in the balance, members of Congress will be in close
communication with physician constituents.

Unable to implement, we have deferred SGR implementation through
fourteen Doc Fixes since 2002, producing what Peter Suderman has
described as the "permanently temporary" decision not to decide what we
think about reining in Medicare physician reimbursement. Now you know
why I would be astonished by any other news, despite the fact that SGR
repeal is rumored to have been included in one of the fiscal cliff
negotiating packages.

Why would the long-contemplated SGR repeal have fallen out of the
fiscal cliff negotiations?  I can only speculate that the fiscal and
political complexity of developing an alternative reimbursement
restraint played some role. So, here we are: continuously overriding a
systemless sytem. Unable to move forward or backward, like crabs we
scuttle continuously sideways.

None of this is news.