CMS: 'Doc fix' is not a long-term solution to physician payment problem

CMS has released a report identifying its concerns with "doc fix" legislation, H.R. 2, which the U.S. House recently passed.

The purpose of the legislation, which was passed with a vote of 392-37 in the House, is to repeal the flawed sustainable growth rate formula and provide a long-term solution to physician payment rate issues that have plagued the healthcare industry for 20 years.

However, Paul Spitalnic, chief actuary for CMS, said he believes subsequent legislation will need to be passed to address the issues. The new payment rates contained in H.R. 2 "would be adequate for many years," Mr. Spitalnic wrote in the report. However, he's concerned with the funding package's 2025 expiration date. He also noted the rates would likely be inadequate in years with high inflation.

Mr. Spitalnic wrote that he anticipates the physician payment rates under the legislation would be lower than scheduled under the current SGR formula within the next 33 years.

"Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2," wrote Mr. Spitalnic.

The U.S. Senate will now consider the legislation, which must be passed by April 15 to prevent a 21 percent cut to physicians' Medicare payments.

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