Lawmakers Close to Deal on Payroll Tax Cut, Medicare 'Doc Fix'

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On Tuesday, the conference committee charged with developing an extension of the payroll tax cut, continuing unemployment benefits and delaying scheduled cuts to Medicare physician reimbursement rates came to a tentative agreement, the New York Times reports (Steinhauer, New York Times, 2/14).

Members of the committee and their aides said the deal still is being finalized, but they are optimistic that an agreement would be announced on Wednesday and approved by Friday (Kane/Nakamura, Washington Post, 2/14).

The announcement came just one day after House Republicans said they would introduce legislation this week to extend the payroll tax break through the end of the year without cost offsets (New York Times, 2/14).

Details of Deal

The tentative agreement would allow Medicare to continue paying physicians at current rates, avoiding a 27.4% reduction in fees set to start on March 1 (Bendavid/Peterson, Wall Street Journal, 2/15). According to aides, the "doc fix" would delay the scheduled cuts for 10 months (Zigmond, Modern Healthcare, 2/14).

The provision is expected to cost about $20 billion (Walker, MedPage Today, 2/14).

The proposal would pay for the delay through cuts to the prevention and public health fund created by the federal health reform law, along with reductions in aid to hospitals with bad debt and other health care-related spending cuts, according to the Times (New York Times, 2/14). During negotiations, Democrats refused to capitulate on cuts that would reduce Medicare benefits, the Post reports.

Aides stressed that the final details -- including how to pay for the "doc fix" -- still were being worked out (Washington Post, 2/14).

Rep. David Camp (R-Mich.), chair of the conference committee, said that conferees have "a structure and a framework" for a deal.

Outlook for Passage?

Following a meeting Tuesday night, House Republicans suggested that the agreement was likely to pass.

Rep. Dennis Ross (R-Fla.) said, "I think you'll see a fair number of dissenters on it." However, he added, "I think they'll have the votes to pass it"(Wall Street Journal, 2/15).

Scott Zettlemoyer
It's time to ask for something in return for the endless unemployment benefits. How about 50 hours a month of job skills enhancement (if there will be jobs in that field) or adult reeducation for career change. Getting paid to do nothing for 2+ years is not an incentive to improve and move-on. If some are hoping for things to improve, someone should tell them this is the new normal. Thing are not going to change much from current situation.
Michael Samms
What if you could eliminate the SGR, (i.e. resolve the Doc Fix issue), AND implement a reimbursement solution to pay for it? What if it saved $100 Billion annually to the U.S. Healthcare system? What if it was offered free to CMS? It is sad that most cost reduction fixes includes an indiscriminate across-the-board freeze for reimbursement regardless of location, rural or urban. We must find a reimbursement innovation that effectively addresses over-served and under-served areas AND preserves primary care physician reimbursement. This reimbursement innovation must be simple and work regardless of any regulatory changes and there must be no interference with a provider's medical and clinical judgment. This innovation must address appropriate levels of services in a specific geographical area, fairly alter reimbursement and preserve appropriate patient services. There is an innovation that represents the solution needed. This innovation can be found at www.sesscoring.com

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