‘Doc Fix’ Dilemma Weighs on More Than Physicians

Physicians who treat Medicare patients wouldn’t be the only health professionals to feel pain if Congress fails to step in to avert scheduled payment cuts at the end of March, or permanently repeal the formula that dictates them.

Any provider who is paid for services under the Medicare physician fee schedule would be affected by the reductions prescribed by the oft-criticized sustainable growth formula, or SGR. The cohort includes nurse practitioners, physician assistants, psychologists, social workers, physical therapists and diagnostic testing facilities.

Hospitals that own physician practices or independent diagnostic testing sites also could be in the mix, according to Josh Seidman, vice president for payment and delivery reform at Avalere Health. And the physician classification also applies to doctors of osteopathy, dentists, podiatrists, optometrists and chiropractors.

The broad grouping illustrates why lobbying to permanently replace the SGR with the bipartisan, bicameral policy compromise worked out in the last Congress is reaching a fever pitch. Disagreements about how to pay for a permanent “doc fix” led lawmakers to pass a payment patch (PL 113-93) averting cuts through March 31.

But with time dwindling and the cost rising – the Congressional Budget Office estimated earlier this month that the compromise legislation would cost $174.5 billion from fiscal 2015 to 2025, up $30.5 billion from November with the addition of a year to the budget window – another temporary patch is increasingly likely.

John Falardeau, senior vice president of government relations for the American Chiropractic Association, said his organization will make a grassroots push next month for Congress to resolve the issue. The group had discussions with House and Senate committee staff and supported the compromise measure last year.  “We are affected just like anyone else,” he said. “We’re all in the same predicament.”

The American Association of Nurse Practitioners also submitted comments while the agreement was being crafted and saw a lot of its feedback implemented in the bill, according to MaryAnne Sapio, vice president of federal government affairs. She called the legislation provider neutral, meaning that it embraces the breadth of Medicare Part B providers.

Similarly, the American Academy of Physician Assistants welcomed the compromise legislation’s equal treatment of physician assistants, doctors and nurse practitioners and wants to ensure any legislation Congress puts forward this year continues that approach. But the group is also hoping to secure additional provisions approved by the Senate Finance Committee last Congress allowing physician assistants to provide and manage Medicare hospice care and supervise cardiac and pulmonary rehabilitation programs in critical access hospitals.  “By doing so, Medicare recipients will fully benefit from the high-quality care that PAs provide,” Tillie Fowler, senior vice president of advocacy and government relations, said in a statement.

For psychologists, the potential for SGR cuts and the underlying payment scheme are a source of angst.

Laurel Stine, director of congressional affairs for the American Psychological Association, said psychologists comprise more than 70 percent of inpatient mental health care for Medicare beneficiaries and almost half of outpatient care. They want the SGR permanently repealed, and, having faced an erosion of Medicare reimbursements, are also looking ahead at how to adjust the broader payment methodology, Stine said.

The current system squeezes out payments for psychologists who are limited to a narrow set of codes, have many time-based services and use notebooks rather than technologically-intensive equipment, Stine added.  “The underlying payment formula works against us,” she said.

Robert M. Wah, president of the doctors’ lobby the American Medical Association, has said he doesn’t like the term “doc fix,” asserting that it’s Medicare – not doctors – that needs to be fixed. But the range of providers affected by the cuts may be another reason to ditch the nickname in favor of the buzzword SGR.  “For years it’s been called the doc fix,” said Sapio of the nurse practitioners group. “Those providing care have changed over the years.”

See the original article on the CQ Roll Call website.