American Society of Hematology

Congressional Committees Ponder Physician Payments

Published on: July 25, 2012

Before the Congress breaks for its month-long August recess, the congressional committees responsible for assembling a proposal to overhaul the Medicare physician payment formula conducted hearings to weigh options:

On July 18 during a Committee on Energy & Commerce meeting, Representative (and physician) Michael C. Burgess (R-TX) unveiled a one-year extension bill (HR 6142) to extend relief from planned end-of-the year physician payment cuts. However, Representative Burgess's measure does not include a way to pay for it, so it is not expected to move forward.

On July 24, a House Ways and Means panel returned to the topic in a hearing with physician groups.

The committee sessions offer a reminder to lawmakers that the current payment fix for physician payments expires at the end of the year, which is a part of the continuous adjustment of Medicare payment rates since the formula became unsustainable in 2002.

In previous years, payment adjustment efforts focused on halting or delaying planned cuts in physician payments, not on creating novel new payment approaches. The health care overhaul law in 2010 offered the last major opportunity to completely eliminate the payment formula, but the long-term cost of over $200 billion impinged on the law's overall cost. However, in 2009 amid debate on the health care law, the House of Representatives adopted a non-offset permanent fix that included a new payment emphasis on primary and preventive care services and allowed most payments to grow at the rate of gross domestic product (GDP) plus one percent and preventive and primary care services would be allowed to grow at GDP plus two percent. The Senate did not consider the 2009 House physician payment measure.

Last year, the Medicare Payment Advisory Commission outlined a new payment proposal. Recently, the continuing lack of a bipartisan agreement on offsetting spending or tax increase has hindered action on a complete fix of physician payments more than the any disputes over details on an alternative payment plan. The topic is now mired as an adjunct part of a range of yearend topics that most likely a "lame duck" congress will determine.

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