That’s especially disconcerting, he says, because Congress spends more on temporary patches than the cost of actually fixing the problem, and each individual patch costs more each year. (See “We Don’t Need No Stinking Patches,” opposite page.)
That’s also why TMA and AMA continue to urge Congress to quickly pick up where they left off. The higher that price tag gets, the more politically difficult a solution becomes, Mr. Whitehurst says. So when the CBO significantly reduced that estimate, “it finally put this in the realm of the doable.” But the financing proposals put forth this year by the Re- publican-controlled House and Democratic-controlled Senate were so politically charged that neither could really survive: The House on March 14 passed the Medicare pay fix with mon- ey from a five-year delay in the Affordable Care Act individual mandate — a nonstarter in the Senate, which never took up the bill. Senate Democrats, on the other hand, floated the idea of using unspent war money, known as “OCO,” or Overseas Contingency Op- erations, funds — also a non- starter in the House.
Patch #17 With no agreement and the clock ticking down to the March 31 deadline, Congress hastily passed a $21 billion patch with opposition from AMA and some other physi- cian organizations. President Barack Obama signed it into law on April 2.
In lieu of the comprehen-
sive reforms, the Protecting Access to Medicare Act of 2014 extends the current 0.5-percent payment increase through the end of this year and freezes payment rates until April 1, 2015. It also:
• Extends the geographic adjustment (GPCI) “floor” of 1.0 for physician work in the Medicare fee schedule for 12 months.
• Delays implementation of the ICD-10 diagnosis coding set by one year, until Oct. 1, 2015.
• Pays for the patch through various payment cuts to hospi- tals, “misvalued” physician services, and certain diagnostic tests and imaging equipment.
• Gives the U.S. Health and Human Services secretary dis- cretion to continue suspending recovery audit contractor (RAC) postpayment audits under the “2-Midnight” policy through June 2015.
• Broadens the impact of the across-the-board Medicare “se- quester” cuts required by federal spending reductions to control the national deficit.
The patch was not Congress’ first choice, says House Ways and Means Health Subcommittee Chair Kevin Brady (R-Texas). But the reform bill lost what he called “valuable momentum” during the unexpected transition from Sen. Max Baucus (D- Mont.) to Sen. Ron Wyden (D-Ore.) as chair of the Senate Finance Committee in February, right after the House bill was introduced. Both chairs supported the effort, “but that was just a ma-
“Once again, we’re brought to the cliff with our feet dangling off, wondering if we are going to get pulled back. It’s painful and exhausting, and in the end we are just trying to take care of our patients.”
jor transition, and we lost a good six weeks of momentum in a time when we hoped to gather momentum. Unfortunately, that left us with facing a lapse [in physician payments], which was absolutely unacceptable.” (Senator Baucus resigned the Senate in February to become U.S. ambassador to China.) Representative Brady says the financing proposals were nevertheless “sincere” efforts by both sides to keep moving the legislation forward and get both parties to the ne- gotiating table on an agree- able pay-for solution. He pointed to other potential options, including savings from structural reforms of Medicare like combining parts A (hospital services) and B (physician services) or capping seniors’ out-of- pocket costs. Finding the money “will be difficult. But it is doable,” he said. “It’s just going to take some hard work. But this is significantly different than in the past where there was no solution within 100 miles of the table, and the only discussion was how
long a patch would be. Now we have [a policy]. We have a cost and a price to negotiate toward and a real incentive to get this done. So there is a much stronger urgency and buy-in from all parties.” U.S. Rep. Henry Cuellar (D-Texas) also hesitantly supported the patch over what he agreed was significant progress toward a permanent fix. But the House Appropriations Committee member criticized House Republicans for killing the momen- tum with an unworkable pay-for solution. “We were able to sit down in a bipartisan way to figure out how to fix [the SGR problem]. We also have to make sure we sit down to come up with a bipartisan agreement to pay for it.”
Cycle of uncertainty
Meanwhile, physicians and patients are stuck in another cycle of uncertainty, with tough decisions to make about Medicare participation. (See “Medicare: In or Out?” page 26.) TMA reluctantly supported the patch but preferred a long-
overdue permanent fix, Dr. King says. Each year, the faulty SGR requires fee cuts to offset growing demand for Medicare
June 2014 TEXAS MEDICINE 25
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