Allyne Caan / April 16, 2015

The ‘Doc Fix’ Will See You Now

Unfortunately, the solution may prove worse than the problem.

In a Congress known for enacting temporary stopgap measures to save face while repeatedly kicking the proverbial can down the road, legislators actually did something permanent this week. Unfortunately, the solution may prove worse than the problem.

On Tuesday, the Senate, by an overwhelming 92-8 vote, passed the Medicare Access and CHIP Reauthorization Act of 2015, a Medicare overhaul bill commonly known as the “doc fix.” The bill, which the House passed last month with 392 votes, will end the annual threats of Medicare-reimbursement cuts to doctors stemming from the 1997 Sustainable Growth Rate (SGR) law. Under SGR, Medicare’s budget was calculated by linking Medicare spending to economic growth. This became problematic once health care costs began rising faster than the growth of the economy — meaning, physicians were regularly at risk of Medicare reimbursement cuts. So, 17 times over the last 14 years, Congress passed temporary “doc fixes” to protect physician reimbursements. The new measure eliminates the need for these fixes by repealing the SGR law.

It sounds well and good at first glance — and, indeed, a permanent fix was needed for a flawed system — but beware of bipartisan legislation that sounds well and good. For starters, the bill adds at least $141 billion to the federal deficit over the next 10 years. Remember all those Republican promises of fiscal responsibility? Well, the dodo bird’s got nothing on them.

To his credit, Republican Senator Mike Lee of Utah introduced an amendment removing the bill’s exemption from the 2010 Statutory Pay-As-You-Go Act (PAYGO) — signed, laughably, by Barack Obama — which requires spending increases be offset by savings elsewhere within the same legislative session. The amendment failed 42-58. Additionally, Republican Senator John Cornyn of Texas proposed paying for the bill by repealing ObamaCare’s individual mandate; this amendment, which needed 60 votes to pass, failed 54-45.

So, thanks to the brave Republican majority, the president will soon sign into law a $141 billion increase to our federal deficit.

Sadly, though, this may not be the worst of it. The bill entrenches government even more in the exam room through increased federal controls and a national link-up of patient electronic health records (EHRs).

First, the bill offers physicians two questionable payment models: either a Merit-based Incentive Payment System (MIPS), under which physicians will be paid based on how well they comply with certain federal quality metrics (metrics which, incidentally, have yet to be determined), or an “alternative payment model” in which a group of doctors bands together to receive lump-sum payments to care for patients. If those physicians can deliver the care for less, and, of course, meet those “quality metrics,” then they benefit from some of the leftover funds.

If you liked ObamaCare regulating your insurance options, then you’ll love government rating your doctors.

Second, the bill paves the way and plants flowers alongside the road for mandatory connectivity of patient data nationwide. Section 106(b) states, “Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018.” In other words, this doc fix requires EHRs to become “interoperable” so Americans’ private medical information can be shared nationwide. That could improve convenience for referrals, but, given the horrible security performance of Healthcare.gov, it’s not terribly comforting to know medical records could be hacked.

Of course, none of this should be surprising given that the bill was originally brokered by Nancy “You-have-to-pass-the-bill-to-find-out-what’s-in-it” Pelosi and John “How-else-can-we-cave-to-Democrat-demands?” Boehner. Still, the fact that it passed so overwhelmingly in both the House and Senate demonstrates the power rhetoric holds over principle for the vast majority of our nation’s elected officials.

The “fix” may be in, but the cure is worse than the disease.

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