Physicians have had to live under a series of payment 'fixes' which get harder and harder to enact because even a freeze in physician fees is counted against the deficit. Senate passes 'doc fix'

House Speaker Nancy Pelosi rejected the Senate-passed bill that would fully restore Medicare payments to physicians, further dragging out a payment nightmare for doctors that started June 1.

After squabbling for weeks over a broad tax extenders package that already cleared the House, the Senate passed a stand-alone, $6.4 billion patch to stop a 21 percent cut in the rate at which doctors are paid for treating Medicare patients. The narrow bill was passed by unanimous consent Friday after Republicans objected to the Democrats' larger plans earlier in the week.


But Pelosi said late Friday that the Senate-passed bill was "a great disappointment" and she saw "no reason to pass" it.

"The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs," Pelosi said in a statement. "The House has repeatedly sent jobs—creating bills to the Senate since December—Build America Bonds, small business hiring incentives, and importantly, summer jobs—and yet Republicans continue to block approval of jobs legislation.

Under the Senate-passed bill, the payment cut would eliminated and a 2.2 percent raise would be applied to Medicare reimbursements through Nov. 30. Senate Finance Committee Chairman Max Baucus and ranking Republican Charles E. Grassley came up with the deal late Thursday.

The 21 percent reduction results from an erratic Medicare reimbursement formula dating back to Republican control of Congress and one neither party has been able to fix on a permanent basis. In the interim, physicians have had to live under a series of so-called "doc-fixes" which get harder and harder to enact because even a freeze in physician fees is counted against the deficit.

This has been especially true this spring given the coming elections and Republican anger at President Barack Obama’s healthcare agenda. The extension now is fully offset with a combination of hospital savings and pension changes approved by the Senate Finance Committee. But these will now have to pass muster with the House as well before going to the White House.

Before the Senate passed the repair, Vice President Joe Biden scolded Republicans for opposing the extenders bill on Thursday.

"As a nation, we have a responsibility to fix this problem, so that our doctors can get paid for the lifesaving services they provide for our seniors," Biden said. "And Republican leaders, I would respectfully suggest, have an obligation, a responsibility to stop walking away from these needs, stop playing brinksmanship and politics with this every time it rolls around, and fix this problem."

Republicans said they opposed the extenders bill because it wasn’t paid for and they don’t want to add to the nation’s rising debt.

The latest reduction in the Medicare repayments took effect June 1, but the Centers for Medicare & Medicaid Services (CMS) had instructed contractors to hold back claims for two weeks given the promise of a congressional reprieve.

That hold was again extended through Thursday—or 17 days altogether. But CMS ordered contractors Friday morning to begin processing claims with the reduction in effect.

Claims can be reprocessed once Congress has finally approved the new stay, but the whole picture is not one of a smooth running government.

The American College of Physicians warned that Congress is "playing with fire" by messing around with short-term fixes and delayed payments.

"I have never seen physicians more frustrated with the cuts and cynical about Congress’ willingness or ability to do the right thing for patient access," said Bob Doherty, a senior vice president at the American College of Physicians. A short-term repair "will confirm the growing sentiment among doctors and seniors that Medicare is an unreliable and unstable partner that can't be counted on to pay its bills, and more of them accordingly will limit how many Medicare patients and seniors they can afford to see."

The American Medical Association says it has run out of patience.

"This is no way to run a major health coverage program – already the instability caused by repeated short-term delays is taking its toll," said AMA president Cecil B. Wilson. "Congress has finally taken its game of brinkmanship too far, as the steep 21 percent cut is now in effect and physicians will be forced to make difficult practice changes to keep their practice doors open."

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