Poison Pill Scuttles Bipartisan Permanent Doc Fix

Congressional Republicans have thrown a huge monkey wrench into a previously bipartisan effort to fix CMS’ much maligned sustainable growth rate (SGR) formula. The bipartisan deal was agreed to in early February.

“It’s a sad state of affairs, ” Thomas Barber, M.D., a lobbyist for the American Academy of Orthopaedic Surgeons, told Reuters. “To see something that was supported by both parties get shanghaied into the partisan politics of the day is very frustrating.”

Barber was responding to a bill that passed the Republican-controlled U.S. House of Representatives on March 14, 2014 that included a “Poison Pill” provision delaying the implementation of the Affordable Care Act (ACA) for five years. Replacing the SGR will cost $138 billion. Republicans wanted that money to come out of the ACA. The President has promised to veto any bill with such a provision and Senate leaders have said they would not consider such a bill in their chamber.

The bill, passed by the House on a 238-181 vote, would repeal the SGR and replace it with a “quality-based rewards” model and provides incentives to physicians participating in alternative payment models.

Physicians will see a 24% cut in Medicare payments on April 1, 2014 unless a “Doc Fix” is found or another temporary patch is put in place.

“Just last month, both parties worked in a bicameral process to develop good-faith consensus and were historically close to repealing the dysfunctional payment system and improving healthcare for America’s senior citizens. It would be a shame for lawmakers to have done all of that hard work only to have it overcome by partisan politics over budgetary issues, ” American Medical Association President Ardis Dee Hoven, M.D. said in a statement after the news broke.

The consensus came after several years of collaborative work by the Republican and Democratic leaders of the key congressional committees that oversee the Medicare program. The leaders, from both houses of Congress, also got input and buy-in from physician groups, and from groups representing Medicare patients.

Fred Upton, the Republican chair of the House Energy and Commerce Committee defended the insertion of the delay of the ACA’s implementation by citing a list of other parts of the health law that the Obama Administration has already delayed. “If the Administration has decided to delay all these things—almost two dozen—why not delay this, too?” he said. “And why not use the savings then, not only to help the physicians…it’s to help the most vulnerable, our seniors.”

“The bill you have on the floor today is not the destination, ” said Representative Michael Burgess, M.D., a Republican from Texas. “It is the key that gets you through the door that gets you to the destination, ” he reportedly said.

The bipartisan optimism expressed in February has disappeared for now. With mid-term elections on the horizon and the next presidential campaign already underway, kicking the SGR can down the road seems more likely than ever.