Medicare ‘doc fix’ debate in Congress less predictable this year

It’s become an unpleasant ritual for doctors who see patients with Medicare.

Every so often, they are threatened with a devastating cut to their Medicare reimbursements mandated by a rate-setting formula that leaders of both parties agree is flawed but would cost nearly $300 billion to permanently repeal.

Each time, doctors warn they are on the verge of dropping out of Medicare in droves, and the seniors they serve start to palpitate — even though health-industry lobbyists privately concede that there is virtually no chance Congress will actually let the pay cut take effect. And each time, after some down-to-the-wire haggling over how to cover the costs, lawmakers postpone the cuts.

On Friday, Congress passed the latest “doc fix,” delaying a looming 27.4 percent cut for two months as part of a larger deal to extend the payroll tax cut and unemployment benefits. But doctors, lobbyists and Medicare officials alike said this go-around seemed noticeably less predictable.

In an interview hours before congressional leaders announced the deal, Medicare’s deputy administrator, Jonathan Blum, observed that although the previous doc fix — a 13-month postponement agreed to in December 2010 — also was enacted perilously close to a deadline, “there were strong signals [beforehand] that Congress was coming together, and we were able to plan for that. But this, really to me, is a different scenario, where we don’t have clarity about what the timing of the ultimate policy will be.”

The heightened uncertainty surrounding this year’s negotiations eroded doctors’ long-term confidence in Congress, said Alan Wasserman, president of George Washington University Medical Faculty Associates, one of the largest practices in Washington.

“Physicians still think that the people in Congress are too intelligent to let [the pay cut] happen,” he said. “But we are concerned that as the rhetoric keeps getting turned up, and more and more, areas of compromise just aren’t there any more. Sooner or later, there is going to be an impasse.”

With this latest fix expiring on Feb. 29, doctors worry that moment could be around the corner.

“Congress now has to enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for taxpayers,” said Peter Carmel, president of the American Medical Association.

Doctors experienced a hair-raising run of short-term fixes in 2010 — when Congress enacted five separate postponements. And lawmakers actually missed the deadline twice that year, tech­nically allowing the cut to take effect for 14, and then 24 days.

Both times Medicare’s administrators were able to shield doctors by holding off on processing their claims until Congress had enacted the next fix, which then was applied retroactively. But the 24-day hold forced program officials and contractors to work overtime to get through the backlog of claims, Blum said.

That hold also stretched the finances of smaller practices, many of which had to take out loans, according to the AMA.