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The doc fix that failed

5:17 pm by | 0 Comments

The new "fiscal cliff" legislation hailed by some as a "one-year doc fix" of the scheduled 26.5% sustainable growth rate (SGR) cut that was scheduled to take effect on 1 January 2013, has passed the Senate and House as part of the American Taxpayer Relief Act (HR 8) goes to President Obama for his likely signature. But was this "one-year doc fix" really a fix? Not at all. In fact, once again Congress has failed to resolve the ever-present sustainable growth rate cuts that repetitively surface year after year by kicking the proverbial can down the road another year. The cost of the one year patch will be $25.1 billion dollars over 10 years and will be paid for almost entirely by health care cuts in other areas.
  • Hospitals (increasingly doctor-employers now, remember?) will see audits of their billings increase as efforts to recoup some $10.5 billion of "overcoding" charges are seen as the largest source of revenue for the one-year "fix."
  • Hospitals will also see an extension of lower Medicaid payments to hospitals that treat a high number of uninsured or low-income beneficiaries, known as "disproportionate share hospitals" to find savings of about $4.2 billion.
  • Another $4.9 billion offset will be applied to the lowered bundled payments given for patients with end-stage renal disease - some of the sickest people receiving services from Medicare.
  • Also another $1.8 billion will be "saved" to offset the "fix" by reducing payments for multiple procedures that are performed on the same day with patients. Look for more ICD-9 (or ICD-10) code changes for the new year.
  • Also, look for an even greater crackdown on imaging studies as another $800 million has to be found to pay for the "fix."
  • And there's more: the complete list of payments for the "fix," drawn almost exclusively from health care alone, can be found here.
  • Finally, doctors can expect revenue to stay flat result of this "fix" from Medicare, meaning that the payments received will not address costs imposed by annual inflation. (You well-paid primary care doctors, are you listening?)
    • So you see, the "doc fix" is in for another year alright ... ... one that is assured to get even harder to really fix next year.

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      By Westby G. Fisher, MD

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