Congress Takes a Pass on Medicare Fee Cuts

Reversing a long-standing trend, Congress has failed to forestall a major cut in Medicare fees. They've passed a postponement until October 1, but when will they enact the necessary overhaul of the SGR formula?

Reversing a long-standing trend, Congress has failed to forestall a major cut in fees paid to doctors for treating Medicare patients. In a by-now familiar cliff-hanger scenario, Congress did postpone until March 1 a 21% across-the-board fee cut scheduled to kick in on January 1, and then postponed it again until April 1.

This time around, the Senate passed a postponement to October 1, but the House failed to act before leaving for a two-week recess on March 26. According to the House legislative calendar, no vote on the measure will happen until April 13.

Physicians groups, led by the American Medical Association, have long claimed that pegging doctor fees to the sustainable growth rate (SGR) formula has led to unrealistic reimbursements. Putting off fee cuts that are based on the formula has only led to larger and larger threatened cuts each year, leading to the current 21%, the largest in Medicare history.

This year’s delays in implementing the cuts was supposed to give Congress time to study and tweak the SGR formula, which the AMA contends is broken and should be scrapped.

Some Congressional staff members believe that the House will make any action on the fee cuts retroactive to April 1. That’s not good enough, according to AMA president J. James Rohack, MD, who attacked lawmakers for leaving Washington without settling the issue.

In a statement issued on the day Congress left town, Rohack said that failure to fix the reimbursement formula jeopardized access to healthcare for seniors and military families. The cuts also impact doctors who participate in the TRICARE program, which serves active duty military personnel and their families.

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