Physician payments are in limbo following a vote by the U.S. House of Representatives on Dec. 20 not to approve a 2-month extension of current Medicare payment rates to physicians.
The House voted 229 to 193 to disagree with legislation passed earlier by the Senate, which would have prevented a scheduled 27% Medicare physician fee cut through the end of February. The resolution also requested a House-Senate conference to resolve differences in legislation aimed at averting a steep physician pay cut, extending the Social Security payroll tax holiday, and continuing federally funded unemployment insurance benefits.
But getting agreement from a conference committee before the end of the year appears unlikely, since Democrats in the Senate have said they will not participate in the conference process. They have argued that the conference would be unnecessary if Republicans in the House would agree to the Senate’s proposed 2-month extension.
The American Medical Association blasted Congress for its failure to enact a physician pay fix. "Congress has again failed to fulfill its responsibilities. It is shameful that patients and physicians are the collateral damage; the citizens of this country deserve better," Dr. Peter W. Carmel, the AMA president, said in a statement. "Congress had the entire year to repeal the broken physician payment formula and provide stability for the millions of seniors and military families who rely on Medicare and TRICARE, but has failed to act. It is long past time for members of Congress to act decisively and protect access to care for seniors and military families."
If Congress fails to pass a physician fee fix before the end of the year, doctors won’t immediately feel the impact of the 27% cut. Officials at the Centers for Medicare and Medicaid Services plan to hold Medicare payments for the first 10 business days of January. That gives lawmakers until Jan. 17 to come back in 2012 and vote on a plan. The hold would likely have a limited impact on physician cash flow, since electronic claims are paid no sooner than 14 calendar days after being received by CMS.
But if Congress fails to reach agreement, it wouldn’t be the first time. Physicians had begun to feel the effects of a 21% Medicare pay cut in June 2010, when Congress passed legislation to replace it with a 2.2% pay raise for 6 months. In that case, Congress had allowed the cut to go into effect on June 1, and CMS had held payments until June 18. When there was still no agreement from lawmakers, CMS began paying doctors at the lower rate. Once the cuts were reversed, CMS began reprocessing any claims paid at the lower rate.
While averting the deep Medicare physician fee cut has wide bipartisan approval, the issue has been caught up in controversy over other parts of the legislation. On Dec. 13, the House passed the Middle Class Tax Relief & Job Creation Act (H.R. 3630), which would have replaced the 27% Medicare fee cut with a 1% pay raise for physicians in 2012 and 2013. It also included some controversial provisions, including cuts to preventive health funding in the Affordable Care Act and the rollback of certain environmental regulations.
On Dec. 17, the Senate approved an amended version of the bill, extending the payroll tax holiday and unemployment benefits for 2 months, and averting the Medicare pay cut through the end of February. The bill, which passed 89 to 19, was designed to give lawmakers time to work out a long-term deal, but House Republicans rejected the idea, saying they didn’t want to just delay dealing with the problem.