Issue Position: Doctor Payments - Sustained Growth Rates

Issue Position

I know that many are concerned about the problem of Medicare reimbursements to doctors. So, I wanted to share with you the latest developments on this issue.

One of the major problems relating to the Medicare formula is called the Sustained Growth Rate (SGR). In 2010 during the Lame Duck session, the then-Majority Democrats crafted a deal to waive the SGR until December 31, 2011, forestalling a 23% decrease in doctor reimbursements. However, with the new Republican Leadership coming to Congress in 2011, the SGR problem was put on the back burner and the issue of permanent reform to the SGR was shelved. The SGR deadline is fast approaching and the issue now is in a crisis state: if it is not corrected before the end of the year Medicare doctors will face a 27.3% cut in payments. That is just not tenable and will cause doctors to flee the system, leaving seniors with limited access to health care. This is an unacceptable outcome and I am working with others in my caucus to do away with the SGR system entirely and construct new formulae by which doctors will be paid in the Medicare program.

In the meantime, the Democrats (who are now in the minority) proposed a deal to waive the SGR for two years (until January 1, 2014) and provide doctors with a 1% update in 2012 and again 2013. This would be paid for (so it didn't increase the deficit) with a small tax increase on persons who earn $1 million or more. The Majority Leadership accepted the proposal for the two-year SGR fix but changed the tax on millionaires to cuts in other Medicare programs, essentially shifting payments from therapists and hospitals to pay for doctor payments. Their version of the bill also increased Medicare premiums on certain beneficiaries. "Robbing Peter to pay Paul" never works and though this bill (HR 3630) passed the House it did so primarily with Republican votes.

When the bill went to the Senate for approval they amended it to make the bill more temporary in nature so Congress could spend more time on real, permanent solution. When it finished, the Senate had changed HR 3630 so that the SGR "fix" was limited to 2 months. It also changed the payer from other Medicare programs to new FHA fees. Upon passing HR 3630, the Senate recessed until January 16, 2012.

That left the House with a Hobson's choice: accept the Senate version of HR 3630 with only a 2 month reprieve from SGR cuts, or insist on the 2-year SGR fix in House version knowing that, with the Senate gone, passage of the 2-year version would be meaningless.

As much as I would like to give doctors certainty on their fee schedule, I felt it was important to vote for the 2 month bill and send it to the president, thus ensuring the SGR cut of 27.3% would be forestalled at least until February 29, 2012.

Unfortunately, the Republicans had other ideas. They insisted on the 2-year version of the bill and recessed the House. That means there is no agreement with the Senate and no bill will go to the president before the current SGR waiver expires. It also means the 27.3% cuts will take affect January 1, 2012.

CMS believes it can hold off on processing payments under the reduced fee for about a month. If Congress acts before then and passes a waiver that is retroactive there will be no cuts to doctors. That is the best we can hope for at this point and I will work hard to make sure there is no gap in payments to Medicare doctors.

I am deep into this issue. The political wrangling over it has been intense but rest assured that I will continue to fight to get fair and accurate payment to our Medicare physicians.