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.