MACRA significantly increases federal control of the practice of medicine, in line with the ambitions of Obamacare. Doctors will face increasing requirements to comply with federal regulation in order to get paid. These will likely include greater reliance on government-certified Electronic Health Records, which have already proven to frustrate doctors and do nothing to benefit patient care, despite an investment of $30 billion taxpayer dollars.
How Much (More) Will Seniors Pay for a Doc Fix?
To derive these estimates, we divided $175 billion (CBO’s cost estimate of 10-year outlays for H.R.4015/S.2000) by 75 percent (Medicare’s share of Part B spending) to calculate total new Medicare spending for the alternative physician payment system—$233 billion. Under current law, beneficiary premiums would cover 25 percent of total costs, or $58 billion over ten years. In 2015, as in prior years, Part B premiums have taken into account increases in Part B spending due to the SGR overrides. Therefore, in 2016 and future years, the actual increase in the monthly Part B premium is likely to be incremental relative to 2015 levels (but not relative to current law which would result in an actual reduction in Part B premiums – and potentially serious physician access problems). For example, according to the most recent Medicare Trustees report, the standard 2016 monthly Part B premiums are estimated to increase by $1.60,which assumes a fee-schedule update of 0.6 percent from 2015 (comparable to the 0.5 percent update in H.R. 4015/S.2000).
Congress Passes “Doc Fix” – Senate Unable to Improve the Bill for Medicare Beneficiaries
Whenever a temporary “Doc Fix” has been negotiated in the past, beneficiary advocates have largely focused on a number of critical “extenders” – extensions of other temporary Medicare fixes – that have traditionally been part of a larger SGR bill. These extenders include future funding for the Qualified Individual (QI) program that pays Part B premiums for certain low-income individuals, an exceptions process to Medicare’s annual caps on coverage of outpatient therapy services, and funding for outreach and education surrounding low-income programs. Unfortunately, while H.R. 2 “permanently” fixes the SGR formula, it only makes certain of the extenders permanent, and temporarily extends the rest. Absent the larger legislative SGR vehicle, further extension of these programs is less likely.
Good Riddance To One Of Congress’ Dumbest Rituals: The ‘Doc Fix’
This year, Boehner and Pelosi decided to rip off the Band-Aid, and the Senate went along with it despite some squawking by deficit scolds. The House leaders pieced together a package that’s not really paid for and adds to the deficit, and told their respective caucuses to take it or leave it. And it worked! Some Senate Democrats complained a bit because they didn’t get to put their fingerprints on it, and some Senate Republicans protested about the legislation’s effect on the budget. But once Obama enthusiastically endorsed the Boehner-Pelosi deal, they began to quiet down. The House passed the measure 392-37 last month, and the Senate approved it 92-8 Tuesday evening.
Senate overwhelmingly approves ‘doc fix’
The bill will cost $214 billion over 10 years, with $73 billion of that cost offset with spending cuts or new revenue, according to the Congressional Budget Office (CBO). The bill includes reforms to transition Medicare’s payment system from incentivizing quantity to quality in care and is likely to produce small savings for the government over time, according to the CBO.
Obama signs $200 billion ‘doc fix’ bill
In a rare outdoor signing ceremony in the Rose Garden, Obama congratulated Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.) who brokered the deal. “Not only does this legislation permanently fix payments to doctors but it also improves it,” he told reporters. “It encourages us to continue to make the healthcare system smarter, without denying service.” The bill was an uncommon example of bipartisan cooperation. The measure passed the House with an overwhelming majority and on Tuesday, it cleared the Senate with just eight “no” votes. “This was a bipartisan effort, Republicans and Democrats coming together to do something that’s smart and common-sense, and my hope is it becomes a habit,” the president said. Obama said he would congratulate lawmakers for passing the doc fix at a White House ceremony in the next two weeks.