Doc fix in 2011? Don't count on it

I've never been one to make predictions as so many are wont to do at the beginning of a new year. As I see it, making predictions only leads to two possible outcomes: being spectacularly wrong or being spectacularly lucky.

That said, I'm going to break with my instincts and make one prediction for 2011: There will be no Medicare doc-fix of the severely broken Sustainable Growth Rate (SGR) formula this year.

After enduring what doctors went through in 2010 when Congress needed to step up to the plate on four separate occasions -and not always on time--to once again put of the cuts, the year-long delay through the end of 2011 that passed in December may seem like a fix.

Along with the reprieve came all the right words from all the right people. President Obama said "For too long, we have confronted this reoccurring problem with temporary fixes and stop-gap measures. It's time for a permanent solution that seniors and their doctors can depend on, and I look forward to working with Congress to address this matter once and for all in the coming year."

It won't happen.

It won't happen because quite simply it will be seen as too expensive to fix. And in today's Washington with the House under Republican control and the Senate belonging to the Democrats, there simply isn't the political will nor concensus to vote for something that will cost close to $400 billion over ten years.

All of this should have been included in the new health reform law in the first place. Including it, however, would have put the law's price tag well over $1 trillion (with a "T") which alone could have been reform's death knell before it was seriously considered.  The doc fix was also dealt a serious blow in late 2009 by Sen. Harry Reid and few of his senate colleagues when they brought forth a plan that didn't pay for the fix, instead opting to add the projected $250 billion cost to the deficit. We all know how that worked out.

Meanwhile, over the past six years, the stopgap measures to prevent the steep cuts dictated by the SGR haven't really been a win for physicians. Over this time, the Medicare payment patches haven't kept pace with the rapidly rising costs of care. It's a gap that continues to widen.

As a result, it won't take a 25 percent cut in reimbursement rates to make doctors leave the program. They already are leaving, or finding other areas to practice in while trying to prop up their private practices. In rural areas especially, where private practices see a very high percentage of Medicare beneficiaries, even one doctor closing a practice after years of frustration is enough to put a serious crimp in availability of care.

So where does it all end with the price tag getting steeper each successive year, while Congress turns a blind eye?

Well, perhaps the solution will come from CMS itself. My hope is that the Center for Medicare and Medicaid Innovation launched recently to create new models of care and new models of paying for care, can be the answer. Unfortunately, it may be years before their works bears any fruit.

So perhaps the best hope is for Congress to see that it needs more time to figure out how to fix the problem, while also making a commitment to developing the new model with the innovation center.

Needing to patch the payment four times in a single year led to too much uncertainty for doctors and patients alike in 2010. I'd suggest that facing the problem even just once a year still provides too much uncertainty.

Congress should pass a three to five year patch, with modest reimbursement increases for doctors, then let the Center for Medicare and Medicaid Innovation find the care and payment models that will work for the future.

Not that I expect it to happen.