Medicare pay-fix for doctors overdue

The Congress is still prone to terrible political lockups but there is an occasional ray of hope that action is possible on pressing issues. One recent cause for hope was the agreement struck last week in the U.S. House to permanently fix the broken Medicare payment formula for doctors.

There’s been a yearly dance to restore reimbursement rates ever since Congress enacted its “sustainable growth rate” policy in 1997. The policy capped total spending on physician services, but it had the unfortunate effect of forcing either cuts in payment rates to physicians or yearly congressional action to allow spending above the capped level.

A series of short-term “patches” have been enacted at a cost of $170 billion since 2003.

In theory this year’s agreement would end the yearly drama that requires last-minute votes to avoid automatic cuts in Medicare reimbursements to physicians, which this year were estimated to be about 21 percent.

Cuts that deep would be hardships, if not catastrophic for doctors and patients, especially if fewer doctors were to accept Medicare patients.

In a hopeful sign of unusually broad agreement, the House vote was 392 in favor and only 37 opposed to H.R. 2. Support in our state ranged from U.S. Rep. Denny Heck, D-Olympia, to Rep. Cathy McMorris Rodgers, the Spokane-area Republican; no Washington state lawmaker opposed it.

The measure, which is known formally as the Medicare Access and CHIP Reauthorization Act, also has funds to pay for the Children’s Health Insurance Program for two more years and money for community health centers through 2017.

Unfortunately, there was a temporary setback in the Senate where leaders announced one day after the March 26 House vote that they would not vote on the bill until returning from recess on April 13. Senate Majority Leader Mitch McConnell, R-Kentucky, assured a vote would occur soon and he expressed confidence the votes were there to complete the deal.

McConnell and the Senate need to deliver.

In the meantime, doctors in Washington are left to twist a bit longer on the congressional rope.

This year, doctors can likely hold back their April billings for Medicare patients for at least a short while, buying time until this is sorted out.

The Washington State Medical Association, which represents physicians, noted that the federal Centers for Medicare and Medicaid Services are instructing carriers to hold claims for 10 business days for services provided after April 1.

WSMA, which represents the state’s doctors, supports the bill as a permanent end to the yearly drama over if or when the Congress can fix the reimbursements.

Critics of the legislation have questioned its increase in Medicare premiums for some higher-income beneficiaries; some Senate Democrats also have argued it might expand restrictions on using federal funds for abortions, although some pro-choice lawmakers disagree.

But the policy needs changing. Given political realities in the Other Washington, action needs to come quickly, and it should be supported by both sides of the political aisle.