PPACA: Congress Blinks on Medicare Physician Fees

Members of Congress have agreed to once again postpone implementing a repeatedly postponed Medicare program cost-control measure.

The measure, H.R. 4994, the Medicare and Medicaid Extenders Act,: will extend a “fix” to the Medicare physician payment formula through 2011, officials say.

The Senate approved the “doc fix” Wednesday by a voice vote, and the House approved the today doc fix by a 409-2 vote.

Earlier Congress approved a 1-month fix.

Congress stepped in to prevent a 25% cut in Medicare physician payment rates from taking effect Jan. 1, 2011.

Congress has built the “sustainable growth rate” formula into budgets many times over the years, in an effort to address concerns that the Medicare Part B physician services program is consuming a rapidly growing share of the U.S. gross domestic product.

Physicians and patients have objected to the idea of actually implementing the payment formula, and budget analysts at the Congressional Budget Office noted that questions about whether Congress ever will let the payment formula take effect raise doubts about the validity of federal budget forecasts.

Many private health insurers and TRICARE — a health care program for active-duty service members, National Guard and Reserve members, retirees and their families – base their own payment rates on Medicare rates.

Lawmakers paid for the doc fix by changing the rules governing overpayments of the health care affordability tax credit.

“The proposal would change the way people pay back overpayments when they have received more credit than they are eligible for because, for example, they earned more money than expected in a given year,” officials say in a summary of the doc fix measure provisions.

Under current law there is a flat cap of $250 for individuals and $400 for families