Burwell Stresses Need for a Permanent ‘Doc Fix’

Health and Human Services Secretary Sylvia Mathews Burwell told an influential doctors lobby on Tuesday that permanently replacing Medicare’s controversial physician payment formula is an imperative but didn’t offer ideas about how to pay the estimated $174.5 billion cost over a decade.

A leading congressional Republican later predicted Congress would be unable to find a quick solution and instead would pass a six-month payment patch before the end of March to avert scheduled Medicare fee reimbursement cuts of about 20 percent until the end of fiscal 2015.

Burwell used most of an address to the American Medical Association’s national advocacy conference in Washington to tout the benefits of the 2010 health care law, specifically how it saved seniors and people with disabilities more than $15 billion on prescription drugs, or an average $1,598 per beneficiary.  “There are times when we might agree, there are times when we may disagree, but at the end of the day, we all want the same basic things for our country . . .  a better, smarter, healthier health care system,” Burwell told the group, the nation’s largest association of physicians.

The health law (PL 111-148, PL 111-152) was drafted to make prescription drugs more affordable by gradually closing the “donut hole”, a coverage gap where Medicare beneficiaries have to begin paying the full cost of their prescriptions out of pocket before catastrophic coverage kicks in.

Those in the donut hole began receiving discounts in 2011 on covered brand-name drugs and savings on generics. Under the law, the coverage gap will be closed by 2020, with 2015 being considered the halfway point.

The number of preventive services being used by people with Medicare also has increased, Burwell announced. Almost 39 million individuals used at least one preventive service at no cost in 2014, up from 37.2 million, while nearly 5 million used an annual wellness exam, up from 4 million. Such care “allows you to spend more time talking to your patients about what’s important to them,” Burwell said.

With payment cuts to physicians who treat Medicare patients scheduled to take effect April 1 unless Congress intervenes, Burwell added that finding a permanent solution to the oft-criticized sustainable growth rate formula, or SGR, was essential.

But House Budget Committee Chairman Tom Price, speaking directly afterwards, chided Burwell for not offering corresponding cuts to offset the cost and also criticized the health law for narrowing certain types of care networks and diminishing patients’ access to care.

“I was pleased to hear the secretary say that, and I was pleased to hear that she also mentioned the president had it in his budget and a desire for it to be paid for,” Price said. “But they didn’t identify the payfor, which is the challenge we’ve had.”

Price said Congress is all but certain to provide another temporary “doc fix” patch before the end of March, adding a permanent replacement will likely be rolled into legislation to reauthorize the Children’s Health Insurance Program, which expires Sept. 30.

Pressed on his own suggestion for paying for a fix, Price mostly skirted the question by highlighting ideas that have been floated in the past.  “We spend $3.6 trillion a year in this town, to come up with a payfor ought to be relatively easy,” he said. “There are things we have used before. There are areas in federal pensions . . .  and rescission money that’s available out there. We ought to be able to find some resources to pay for the patch.”

The Georgia Republican said that the upcoming Supreme Court case on the legality of the law’s insurance subsidies offers a prime opportunity for Republicans to come up with an alternative. Price introduced his own replacement plan last Congress.

See the original article on the CQ Roll Call website.