PoliticoSenate backs one-year ‘doc fix’ patch
By JENNIFER HABERKORN | 3/31/14 7:37 PM EDT
The Senate on Monday approved a Medicare physician payment bill that would prevent a cut in payments for one year, after lawmakers in both chambers failed to find a permanent solution to the long-simmering problem.
The bill passed on a bipartisan 64-35 vote, and now heads to the president’s desk. Senate Finance Committee Chairman Ron Wyden opposed the patch in favor of a permanent fix.
The latest “doc fix” prevents a 24 percent cut in physician pay and comes after a battle on Capitol Hill over whether to permanently repeal the formula — and the politically dicey question of how to pay for that — or patch it for another year. The bill also delays for a year the ICD-10 implementation of new medical codes.
House Speaker John Boehner and Senate Majority Leader Harry Reid negotiated the patch after it became clear that there was no bipartisan way to pay for the permanent repeal effort negotiated earlier this year. The cut in physician pay would have occurred on Tuesday without the patch.
Wyden had tried to rally support around the permanent bill at the expense of the patch and convinced the major physician groups to back him. But the effort faltered.
“There have now been 16 of these patches — 16 — and every senator that I talk to says that that just defies common sense and it seems bizarre even by Beltway standards,” Wyden said on the Senate floor. “Now is the ideal time for repealing SGR. The cost of full repeal is far less than anticipated.”
The patch passed the House last week in a surprising voice vote amid widespread opposition. House leaders conducted the voice vote with no notice for many of the rank-and-file members. The bill itself was widely opposed even though few members actually wanted the cut to proceed. The voice vote allowed the bill to pass without members having to go on the record in support or opposition.
In addition to patching the cut to doctors, which was called for by the Sustainable Growth Rate, the bill also repeals the health care reform law’s cap on deductibles in small group health plans. It includes several other new policies, too, such as a mental health funding program for community health centers.
It is paid for by pushing the Medicare sequester into 2024, extending cuts to the Medicaid DSH program, requires repairs to codes that set physician payments and makes changes to the way skilled nursing facilities and clinical labs are paid.
It also delays new rules for hospitals in determining inpatient and outpatient status, called the “two midnights” rule.
Earlier on Monday, Wyden tried to pass the permanent repeal of the SGR and paid for with the Overseas Contingency Operations funds but Republican Sen. Jeff Sessions objected. In turn, Sessions proposed an SGR repeal paid for by repealing the health law’s individual mandate. Wyden objected.
Sen. Tom Coburn (R-Okla.) accused leaders of pursuing the quick and easy answer to the impending physician cut instead of finding the money for a long-term patch.
“It got a little hot in the kitchen and instead of actually cooking the omelet, we threw the eggs in the trash can and ran out of the room, and that’s exactly what’s going to happen here,” Coburn said on the Senate floor. “We’re putting off again the hard choices.”