As expected, the Senate has unanimously approved a 12-month postponement of Medicare payment cuts to physicians that were set to kick in January 1, a move widely applauded by physicians' groups and senior advocates that have desperately lobbied Capitol Hill in recent weeks.
The measure now moves to the House of Representatives, where it is also expected to pass.
"The AMA congratulates the Senate for its bipartisan action to preserve seniors' access to care by stopping next year's steep 25 percent Medicare physician payment cut," said Cecil B. Wilson, MD, president of the American Medical Association. "Stopping the cut for one year will inject some much needed stability into the system for seniors and physician practices who have spent this year in limbo because of five short-term delays."
Postponing scheduled decreases in Medicare reimbursements has become a regular occurrence in Washington since 2003, when the formula for determining reimbursement rates began calling for cuts to offset program expenditure overruns. But no year has seen as much chaos as 2010, which required legislators to vote five separate times to head off the cuts.
Opponents have said the cuts would limit access for seniors to doctors. Surveys conducted by medical associations have indicated doctors would either stop seeing Medicare patients, stop accepting new Medicare patients or limit the amount of time they would dedicate to office visits for beneficiaries.
"More than 80 percent of our members – whether Republican, Democrat or independent – are concerned that a Medicare pay cut will threaten access to their doctors," said Nancy LeaMond, an executive vice president for the AARP.
But with the problem now solved for 2011 – and paid for by adjustments to tax credit subsidies that will be provided for some people buying insurance through state health insurance exchanges starting in 2014 – the bigger question is whether Congress will begin working toward a permanent fix in the reimbursement formula.
That could be a hard sell. Congressional Budget Office estimates put the price tag of a fix between $300 billion and $400 billion over 10 years, a big number for politicians to sell to the electorate amid the clamor for deficit reduction.
"I don't think it is reasonable to expect a permanent fix in the next 12 months," said Roland Goertz, president of the American Academy of Family Physicians. "A 12-month window is better than a month and it's better than a gap (in payments). AAFP wanted the 12-month fix in place to create some stability and time to get results of pilots and other demonstration projects on both payment changes and new models of care, particularly the patient-centered medical home."
Any permanent fix will likely require a transitional period of two to five years, Goertz said, in order to put a new comprehensive program in place.
"This will provide stability during that time," he said, "but in that time there must be a proposal for the permanent resolution of this problem, as it has just gone on too long."