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“Doc Fix” – The Continuing Saga of the Sustainable Growth Rate

December 13, 2013 | No Comments
Posted by Frank Ciesla

To continue our reporting on the implementation of the Sustainable Growth Rate (“SGR”), as we write this on Friday the 13th, 2013, both the House and the Senate are considering bills, that would permanently address the SGR solution (euphemistically known as the “Doc Fix”).  The major difference between the two bills being considered is that the House Bill permits a slight annual increase in the rates over a three to four year period and the Senate permits no increase in the rates over a 10 year period.  Both bills do address some methodology of providing additional payments to doctors based upon quality standards.

CMS has already issued regulations reducing the Medicare reimbursement rates starting January 1, 2014 by approximately 24%.

It is clear that the current pending “Doc Fix” legislation” will not be enacted prior to December 31, 2013.  Therefore, unless other action is taken, the reduced Medicare reimbursement rates for physicians will go into effect.

As part of the proposed “budget settlement”, there is a three month delay on the implementation of new Medicare reimbursement rates.  This bill has passed the House and is waiting action by the Senate.  Should this bill pass the Senate and be signed by the President, then the cuts to the Medicare reimbursements will be delayed for three months.  Hopefully, this will provide time for the Congress and the President to enact the “Doc Fix” legislation.

Regrettably neither the Senate version nor the House version of the “Doc Fix” provides adequate reimbursement to cover the increased costs being experienced by physician practices nor does it provide the extra capital necessary for those practices to implement both the electronic and other requirements being imposed upon practices by both legislation and regulations.

Another major hurdle is where Congress will get the money for funding the “Doc Fix”.  It is likely that until that issue is resolved, the “Doc Fix” will not be enacted into law.

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